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1053954503
FARIAHH FAZIL
MOUNT VERNON, IL
NPI
1053954503
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Former Name
FARIA F IMDAD
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: IL 209019228)
Enumeration Date
2019-10-28
Last Update Date
2020-10-19
Business Address
FARIAHH FAZIL FNP-BC
2 GOOD SAMARITAN WAY STE 235
MOUNT VERNON, IL 62864-2476
Phone number: 618-899-3980
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Mailing Address
FARIAHH FAZIL FNP-BC
PO BOX 955860
SAINT LOUIS, MO 63195-2551
Phone number: 636-498-5944
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