Provider Demographics
NPI:1730667585
Name:FABA, KIM MARIE
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:FABA
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 1:5612 E DEER RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49410-8735
Mailing Address - Country:US
Mailing Address - Phone:231-462-3248
Mailing Address - Fax:
Practice Address - Street 1:5612 E DEER RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49410-8735
Practice Address - Country:US
Practice Address - Phone:231-462-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide