Basic Information
| Provider Information | |||||||||
| NPI: | 1003295734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAUST | ||||||||
| FirstName: | DAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8929 OTTER DR | ||||||||
| Address2: | |||||||||
| City: | FARWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486229708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897413200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8929 OTTER DR | ||||||||
| Address2: | |||||||||
| City: | FARWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486229708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897413200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2015 | ||||||||
| LastUpdateDate: | 05/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 372500000X | Y | Nursing Service Related Providers | Chore Provider |
No ID Information.