Provider Demographics
NPI:1174395933
Name:FABIAN, TIFFANY MARIE (CNM)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:FABIAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 MARKET ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-729-7901
Mailing Address - Fax:330-729-7915
Practice Address - Street 1:8423 MARKET ST FL 3
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-729-7901
Practice Address - Fax:330-729-7915
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.0019602176B00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics