Provider Demographics
NPI:1407193881
Name:RIBOUL, BIANCA NAHOMI (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:NAHOMI
Last Name:RIBOUL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3822
Mailing Address - Country:US
Mailing Address - Phone:347-248-3785
Mailing Address - Fax:347-252-0273
Practice Address - Street 1:1604 E 51ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3822
Practice Address - Country:US
Practice Address - Phone:347-248-3785
Practice Address - Fax:347-252-0273
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312292-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse