Mary E Fairbanks, MS, RN, PHN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

R122592-3 Issued in MN

Practice address

522 Minnesota Ave NW
Bemidji, MN 56601-3062

Phone

(218) 444-0488

Fax

(218) 444-0498

NPI assigned

Mar 2, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1528197126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 DORAL DR NE",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566019063",
            "telephone_number": "218-444-0488",
            "fax_number": "218-444-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 MINNESOTA AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013062",
            "telephone_number": "218-444-0488",
            "fax_number": "218-444-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "MARY",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "MS, RN, PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-02",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "MN",
            "license": "R122592-3",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "MN",
            "license": "R122592-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Registered Nurse in Bemidji, MN
• Providers in Bemidji, MN by specialty
• General Practice Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.