Provider Demographics
NPI:1598258543
Name:FABER, ELLEN LONG
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LONG
Last Name:FABER
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 1:1 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-2309
Mailing Address - Country:US
Mailing Address - Phone:302-542-6770
Mailing Address - Fax:
Practice Address - Street 1:1 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-2309
Practice Address - Country:US
Practice Address - Phone:302-542-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0029698163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool