Individual provider · NPI-1

Dawn Fairlie, ANP,GNP,FNP,CDE

Nurse Practitioner, Family · Staten Island, NY

NPI number1174746499

StatusActive

Last updated in NPPESFeb 19, 2009

Details

NPI: 1174746499
Entity type: Individual (NPI-1)
Name: Ms. Dawn Fairlie
Credential: ANP,GNP,FNP,CDE
Sex: Female
Sole proprietor: Yes
Enumeration date: Apr 11, 2007
Last updated: Feb 19, 2009

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LF0000X	Nurse Practitioner, Family	F332587-1	NY	Yes
163WD0400X	Registered Nurse, Diabetes Educator	314022-1	NY
163WM1400X	Registered Nurse, Nurse Massage Therapist (NMT)	26NN06671900	NJ
174400000X	Specialist	F300719-1	NY
174400000X	Specialist	F340111-1	NY
174400000X	Specialist	26NN06671900	NJ

Practice location

4771 Hylan Blvd
Staten Island, NY 10312-6315

Phone 973-216-9898

Mailing address

4771 Hylan Blvd
Staten Island, NY 10312-6315

Phone 973-216-9898

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