Provider Demographics
NPI:1659838183
Name:FADER, GLORIA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:FADER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 M 30
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610-8538
Mailing Address - Country:US
Mailing Address - Phone:989-965-5123
Mailing Address - Fax:
Practice Address - Street 1:1561 M 30
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:MI
Practice Address - Zip Code:48610-8538
Practice Address - Country:US
Practice Address - Phone:989-965-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703065206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse