Fredaz Fares, NP
Nurse Practitioner in Dearborn, MI. Individual provider (NPI-1).
NPI number1336690486
StatusActive
Last updated in NPPESJan 8, 2021
Details
- NPI
- 1336690486
- Entity type
- Individual (NPI-1)
- Name
- Fredaz Fares
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 24, 2016
- Certification date
- Jan 6, 2021
- Last updated
- Jan 8, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 4704317324 | MI | Yes |
Practice location
2040 Monroe St Ste 207Dearborn, MI 48124-2950
Phone 313-278-5836
Mailing address
2040 Monroe St Ste 207Dearborn, MI 48124-2950
Phone 313-278-5836
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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