Provider Demographics
NPI:1053517953
Name:WILLEN, FAYE KLEINBAUM (RN, MSN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:FAYE
Middle Name:KLEINBAUM
Last Name:WILLEN
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:CLINICAL SERVICES & CARE COORDINATION DEPT.
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-3252
Mailing Address - Fax:614-722-4574
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:CLINICAL SERVICES & CARE COORDINATION DEPT
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-3252
Practice Address - Fax:614-722-4574
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05433363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187084Medicaid
OHP09801Medicare UPIN
OH2187084Medicaid