Provider Demographics
NPI:1598109910
Name:ST LOUIS, FABIOLA CADET (LPN)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:CADET
Last Name:ST LOUIS
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 1:775 SAINT JOHNS PL
Mailing Address - Street 2:2H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4274
Mailing Address - Country:US
Mailing Address - Phone:347-879-4029
Mailing Address - Fax:
Practice Address - Street 1:775 SAINT JOHNS PL
Practice Address - Street 2:2H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4274
Practice Address - Country:US
Practice Address - Phone:347-879-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31363-1164W00000X
NY313633-1261Q00000X
NY738900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center