Provider Demographics
NPI:1780223123
Name:FAWBUSH, MELANIE MAY
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MAY
Last Name:FAWBUSH
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 1:8691 HURON DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-9388
Mailing Address - Country:US
Mailing Address - Phone:765-409-0492
Mailing Address - Fax:
Practice Address - Street 1:500 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9501
Practice Address - Country:US
Practice Address - Phone:231-796-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator