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General NPI Number Information
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NPI Number | 1801513049
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Entity Type | Individual
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Provider Name | JUSTINA S FABICH NP
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Gender | Female
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 222 W 4TH ST STE 201
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City | COOKEVILLE
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State | TN
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Zip | 38501-2413
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Country | US
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Telephone | 931-783-4269
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Fax | 931-372-0401
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Provider Business Mailing Address
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Address Line | 140 W 7TH ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-1726
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Country | US
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Telephone | 931-783-5582
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN.CNP.0032564
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 35192
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License Number State | TN
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