Healthcare Provider Details

I. General information

NPI: 1750197547
Provider Name (Legal Business Name): FAYJA LICHTENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E SUPERIOR ST STE 201
DULUTH MN
55802-2228
US

IV. Provider business mailing address

2217 SUSQUEHANNA AVE
SUPERIOR WI
54880-4526
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-5190
  • Fax:
Mailing address:
  • Phone: 218-591-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: