Provider Demographics
NPI:1518287390
Name:VICTOR, FABIENNE (LPN)
Entity Type:Individual
Prefix:
First Name:FABIENNE
Middle Name:
Last Name:VICTOR
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 1:22016 145TH RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3419
Mailing Address - Country:US
Mailing Address - Phone:646-413-5075
Mailing Address - Fax:718-880-4678
Practice Address - Street 1:164 PENN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3046
Practice Address - Country:US
Practice Address - Phone:347-789-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295725-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse