Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 8082 | CT |
NPI | 1063977544 |
---|---|
Provider Name | Stephanie Ann Fadden |
First Address | Philadelphia, PA 19106-1231 |
Second Address | Hartford, CT 06102-8000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2019 |
Last Update Date | 08/02/2019 |