Provider Demographics
NPI:1891396008
Name:FAIRCHILD-EL, BETTY JEAN (CNA)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:FAIRCHILD-EL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20018 NORTHROP ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1256
Mailing Address - Country:US
Mailing Address - Phone:313-454-7891
Mailing Address - Fax:313-537-2418
Practice Address - Street 1:20018 NORHTROP
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219
Practice Address - Country:US
Practice Address - Phone:313-454-7891
Practice Address - Fax:313-537-2418
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide