Healthcare Provider Details

I. General information

NPI: 1639523988
Provider Name (Legal Business Name): FAYE WEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 LANSING AVE
JACKSON MI
49201-7503
US

IV. Provider business mailing address

3231 TRUMBLE LAKE RD
RIVES JUNCTION MI
49277-9728
US

V. Phone/Fax

Practice location:
  • Phone: 517-945-1895
  • Fax:
Mailing address:
  • Phone: 517-945-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number7501003704
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: