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NPI Code Detail

MEDICARE: MAYDIA FACEY FNP

MEDICARE: MAYDIA FACEY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71007758AIN

General Provider Information

NPI Number : 1851890370
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYDIA FACEY FNP
Provider Business Mailing Address
First Line : 1641 S US HIGHWAY 231
Second Line :
City : CRAWFORDSVILLE
State : IN
Zip : 47933-9421
Country : US
Telephone Number : 317-331-0649
Fax Number :
Provider Business Practice Location Address
First Line : 1641 S US HIGHWAY 231
Second Line :
City : CRAWFORDSVILLE
State : IN
Zip : 47933-9421
Country : US
Telephone Number : 765-307-7146
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2018
Last Update Date : 02/10/2018

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