Healthcare Provider Details

I. General information

NPI: 1396256871
Provider Name (Legal Business Name): JENNIFER DAWN FABER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16578 W GREENWAY RD STE 202
SURPRISE AZ
85388-2184
US

IV. Provider business mailing address

16578 W GREENWAY RD STE 202
SURPRISE AZ
85388-2184
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-5900
  • Fax:
Mailing address:
  • Phone: 623-322-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10712
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: