Fairbanks, Michael W

Fairbanks, Michael W is an individual health care provider with primary practice located at 2490 Pass Rd , Biloxi MS 39531-2838. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Fairbanks, Michael W can be contacted via phone (228) 207-9967.

Contact Information

Primary practice address
2490 Pass Rd Biloxi MS 39531-2838
Phone: (228) 207-9967
Fax: (228) 273-1532
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 1-066504 Alabama

Profile Details

NPI number 1215949896
LBN Legal business name Fairbanks, Michael W
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2006
Last updated Jun 27th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215949896 NPPES
Mississippi MEDICAID 02672857
Mississippi Other 900279914
Mississippi Other 1-066504
Mississippi Other 811413110
Mississippi Other 900279914
Mississippi Other 900279914

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