Basic Information
| Provider Information | |||||||||
| NPI: | 1225232952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAUQUIER | ||||||||
| FirstName: | LORI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 MARINERS ISLAND BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944041560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722174557 | ||||||||
| FaxNumber: | 8883527383 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 MARINERS ISLAND BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944041560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722174557 | ||||||||
| FaxNumber: | 8883527383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 04/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | 26NN8867700 | NJ | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 363LW0102X | F420560 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 8630704 | 05 | NJ | MEDICAID |