Healthcare Provider Details

I. General information

NPI: 1134870710
Provider Name (Legal Business Name): DANIELLE FABIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 76-228-6602
  • Fax: 207-622-8661
Mailing address:
  • Phone: 76-228-6602
  • Fax: 207-622-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211637
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: