Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 75637 | WI |
N | 207PP0204X | Pediatric Emergency Physician | C1-0012766 | DE |
N | 208000000X | Pediatrician | 0116028464 | VA |
NPI | 1003294547 |
---|---|
Provider Name | Kendra L Fabian |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2015 |
Last Update Date | 24/08/2021 |