Provider Demographics
NPI:1790552073
Name:FARAJ, HAWIRAH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HAWIRAH
Middle Name:
Last Name:FARAJ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4015
Mailing Address - Country:US
Mailing Address - Phone:313-445-0115
Mailing Address - Fax:
Practice Address - Street 1:4900 MERCURY DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2947
Practice Address - Country:US
Practice Address - Phone:313-816-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704346161363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care