Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
N | 175F00000X | Naturopath |
NPI | 1174153407 |
---|---|
Provider Name | Mrs. Stefanie Lyn Fario |
First Address | Port Wentworth, GA 31407-5602 |
Second Address | Port Wentworth, GA 31407-5602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2020 |
Last Update Date | 01/06/2020 |