Provider Demographics
NPI:1417663717
Name:FADEL, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:FADEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1177
Mailing Address - Country:US
Mailing Address - Phone:440-759-1100
Mailing Address - Fax:
Practice Address - Street 1:1917 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1177
Practice Address - Country:US
Practice Address - Phone:440-759-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide