Provider Demographics
NPI:1972018273
Name:FANA, ABIGAIL SARAH (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:SARAH
Last Name:FANA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21720 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5530
Mailing Address - Country:US
Mailing Address - Phone:248-756-7802
Mailing Address - Fax:
Practice Address - Street 1:21720 INDIAN CREEK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5530
Practice Address - Country:US
Practice Address - Phone:248-756-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294535367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife