Individual
FARES N MUBAREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5000
Mailing address
3970 TROWBRIDGE ST, HAMTRAMCK, MI 48212-4103
(313) 384-6943
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4704298299
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704298299
MICHIGAN STATE BOARD OF NURSING
MI
Enumeration date
04/29/2019
Last updated
09/18/2019
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