Healthcare Provider Details

I. General information

NPI: 1962320648
Provider Name (Legal Business Name): JASON NATHANIEL FABER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 MAPLETON DR
WEST LINN OR
97068-2127
US

IV. Provider business mailing address

4025 MAPLETON DR
WEST LINN OR
97068-2127
US

V. Phone/Fax

Practice location:
  • Phone: 503-998-5431
  • Fax:
Mailing address:
  • Phone: 503-998-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: