Provider Demographics
NPI:1053056382
Name:FARIA, JEANETTE (BS, RRT, RPFT, IHP2)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:FARIA
Suffix:
Gender:F
Credentials:BS, RRT, RPFT, IHP2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-4105
Mailing Address - Country:US
Mailing Address - Phone:248-686-6500
Mailing Address - Fax:
Practice Address - Street 1:1047 CHESTER ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-4105
Practice Address - Country:US
Practice Address - Phone:248-686-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4401004632227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4401004632OtherREGISTERED RESPIRATORY THERAPIST