Provider Demographics
NPI:1679292841
Name:FABIAN, ALEXANDRIA LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LYNNE
Last Name:FABIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 SARCHETS RUN RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9558
Mailing Address - Country:US
Mailing Address - Phone:740-705-2476
Mailing Address - Fax:
Practice Address - Street 1:817 FOREST AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2820
Practice Address - Country:US
Practice Address - Phone:740-454-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant