Provider Demographics
NPI:1063481943
Name:FABER, KATHY S (FNP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:S
Last Name:FABER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84907 EDENVALE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97455-8600
Mailing Address - Country:US
Mailing Address - Phone:541-747-6362
Mailing Address - Fax:
Practice Address - Street 1:3525 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3866
Practice Address - Country:US
Practice Address - Phone:541-687-8581
Practice Address - Fax:541-343-1411
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262932Medicaid