Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP01233 | LA |
NPI | 1205009560 |
---|---|
Provider Name | Michelle M Fabacher |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 24/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03432767 | (05) | MS |
1133906 | (05) | LA |