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General NPI Number Information
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NPI Number | 1770657843
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Entity Type | Individual
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Provider Name | DARNELL FAIRBANKS
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1334 FLAMMANG DR
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City | WATERLOO
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State | IA
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Zip | 50702-4366
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Country | US
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Telephone | 319-233-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 CHESHIRE LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3706
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Country | US
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Telephone | 888-510-0766
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Fax | 763-268-4240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 00534
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License Number State | IA
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