Active NPI
Michelle Dawn Fairbanks, ADULT FOSTER CARE
- Foster Care Agency
- Hibbing, MN
National Provider Identifier
1194181768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foster Care Agency
- License
- 1049904
- Practice address
- 1408 Gray Dr
Hibbing, MN 55746-3460 - Phone
- (218) 263-8331
- NPI assigned
- Jan 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foster Care Agency | 253J00000X | 1049904 | MN | Primary |
Addresses
Primary practice location
1408 Gray Dr
Hibbing, MN 55746-3460
Mailing address
1408 Gray Dr
Hibbing, MN 55746-3460
Phone (218) 263-8331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1049904 | MN | MD | Foster Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452556800000",
"number": "1194181768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1408 GRAY DR",
"city": "HIBBING",
"state": "MN",
"postal_code": "557463460",
"telephone_number": "218-263-8331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1408 GRAY DR",
"city": "HIBBING",
"state": "MN",
"postal_code": "557463460",
"telephone_number": "218-263-8331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRBANKS",
"first_name": "MICHELLE",
"middle_name": "DAWN",
"name_prefix": "Ms.",
"credential": "ADULT FOSTER CARE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-12",
"last_updated": "2016-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "253J00000X",
"taxonomy_group": "",
"desc": "Foster Care Agency",
"state": "MN",
"license": "1049904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hibbing, MN
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- Gary D Eustice, MS LP
- Eye Clinic North, Professional Association
- Kimberly Ann Fagan
- Fairview Health Services (Fairview Hibbing Home Medical Equipment)
- Fairview Pharmacy Services LLC
- Fairview Ranjie Reg HLTH SVS (Fairview Mesaba Pharmacy)
- Megan Marie Finckbone, LPCC
- Paula Fink, LMT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.