Provider Demographics
NPI:1568731750
Name:LUCIEN, FABIENNE
Entity Type:Individual
Prefix:MRS
First Name:FABIENNE
Middle Name:
Last Name:LUCIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FABIENNE
Other - Middle Name:
Other - Last Name:DALLEMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22003 145TH RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3420
Mailing Address - Country:US
Mailing Address - Phone:718-785-3092
Mailing Address - Fax:
Practice Address - Street 1:22003 145TH RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3420
Practice Address - Country:US
Practice Address - Phone:718-785-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308606-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse