Provider Demographics
NPI:1639544166
Name:FABIAN, JILL MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:FABIAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:REINHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1141 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1639
Mailing Address - Country:US
Mailing Address - Phone:330-509-3788
Mailing Address - Fax:
Practice Address - Street 1:1622 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6613
Practice Address - Country:US
Practice Address - Phone:330-399-7215
Practice Address - Fax:330-399-2411
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.315355-1163W00000X
OHCOA.18459-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse