Provider Demographics
NPI:1750153482
Name:FAIRBANKS, IYONNA L (PROVIDER)
Entity type:Individual
Prefix:
First Name:IYONNA
Middle Name:L
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 CEDAR AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2836
Mailing Address - Country:US
Mailing Address - Phone:513-365-3233
Mailing Address - Fax:
Practice Address - Street 1:1677 CEDAR AVE APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2836
Practice Address - Country:US
Practice Address - Phone:513-365-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty