Basic Information
| Provider Information | |||||||||
| NPI: | 1063481943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FABER | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84907 EDENVALE RD | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974558600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417476362 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3525 HILYARD ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974053866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416878581 | ||||||||
| FaxNumber: | 5413431411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 262932 | 05 | OR | MEDICAID |