Healthcare Provider Details

I. General information

NPI: 1750204137
Provider Name (Legal Business Name): DANA NICOLE FAIRBANK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W IRVINGTON RD
TUCSON AZ
85746-8425
US

IV. Provider business mailing address

11651 E GRANITE BUTTE DR
TUCSON AZ
85747-6283
US

V. Phone/Fax

Practice location:
  • Phone: 520-404-4147
  • Fax:
Mailing address:
  • Phone: 520-404-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number151241
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: