Provider Demographics
NPI:1780904151
Name:FAUVERGUE, NANCY JANE (RN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JANE
Last Name:FAUVERGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 TULIP DR S
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-7594
Mailing Address - Country:US
Mailing Address - Phone:317-847-3959
Mailing Address - Fax:
Practice Address - Street 1:4330 TULIP DR S
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-7594
Practice Address - Country:US
Practice Address - Phone:317-847-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28137587A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies