Provider Demographics
NPI:1407526619
Name:FABER, JESSICA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:FABER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:SIMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 E CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-7003
Mailing Address - Country:US
Mailing Address - Phone:989-246-9430
Mailing Address - Fax:
Practice Address - Street 1:1105 E CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-7003
Practice Address - Country:US
Practice Address - Phone:989-246-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704312158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily