Provider Demographics
NPI:1053729160
Name:FAIRCHILD, TELANA NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:TELANA
Middle Name:NICOLE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GRAFTON COMMON
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519
Mailing Address - Country:US
Mailing Address - Phone:508-466-7120
Mailing Address - Fax:
Practice Address - Street 1:28 GRAFTON COMMON
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519
Practice Address - Country:US
Practice Address - Phone:508-466-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily