Healthcare Provider Details

I. General information

NPI: 1316353055
Provider Name (Legal Business Name): DAWN E FAIRBURN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 E US HIGHWAY 36
BAINBRIDGE IN
46105
US

IV. Provider business mailing address

1100 SOUTHFIELD DR SUITE 1370
PLAINFIELD IN
46168-4498
US

V. Phone/Fax

Practice location:
  • Phone: 765-522-1889
  • Fax: 765-522-3583
Mailing address:
  • Phone: 317-837-5570
  • Fax: 317-837-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71004960A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: