Individual
BELINDA DIANE FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1481 E 1300 S, KOKOMO, IN 46901-7622
(765) 432-5296
Mailing address
1481 E 1300 S, KOKOMO, IN 46901-7622
(654) 325-2967
(765) 689-7257
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
17001101A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000392105
BLUE CROSS PROVIDER
IN
Enumeration date
10/05/2006
Last updated
02/04/2021
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