Healthcare Provider Details

I. General information

NPI: 1417781360
Provider Name (Legal Business Name): JENNIFER LEE FABROWICZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LEE MEEGAN FNP-C

II. Dates (important events)

Enumeration Date: 08/31/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 W 400 N
MICHIGAN CITY IN
46360-9330
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-0333
  • Fax: 219-879-0325
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04240406
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015741A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: