Provider Demographics
NPI:1679235477
Name:FABE, REXEL JOHN PABLO (NP)
Entity Type:Individual
Prefix:MR
First Name:REXEL JOHN
Middle Name:PABLO
Last Name:FABE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5992 YELLOW RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2136
Mailing Address - Country:US
Mailing Address - Phone:217-819-1115
Mailing Address - Fax:
Practice Address - Street 1:5992 YELLOW RIDGE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2136
Practice Address - Country:US
Practice Address - Phone:217-819-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845936363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology