Healthcare Provider Details

I. General information

NPI: 1225147101
Provider Name (Legal Business Name): KIMBERLY R FAUCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 SOUTH MAIN STREET SUITE 101
WILLITS CA
95490
US

IV. Provider business mailing address

1155 SOUTH MAIN STREET SUITE 101
WILLITS CA
95490
US

V. Phone/Fax

Practice location:
  • Phone: 707-456-1100
  • Fax: 707-456-1101
Mailing address:
  • Phone: 707-456-1100
  • Fax: 707-456-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG74987
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD00036004
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: