Provider Demographics
NPI:1477900777
Name:SAINT-SUME, FABIOLA (LPN/ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:SAINT-SUME
Suffix:
Gender:F
Credentials:LPN/ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 DECEMBER DR APT 202
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3616
Mailing Address - Country:US
Mailing Address - Phone:202-733-0813
Mailing Address - Fax:
Practice Address - Street 1:1514 DECEMBER DR APT 202
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3616
Practice Address - Country:US
Practice Address - Phone:202-733-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006733164W00000X
MDLP48464164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1477900777Other1477900777