Provider Demographics
NPI:1932511029
Name:PIERRE, FADJANA (RN)
Entity Type:Individual
Prefix:
First Name:FADJANA
Middle Name:
Last Name:PIERRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-28 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95-25 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:347-987-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2017-12-15
Deactivation Date:2017-03-29
Deactivation Code:
Reactivation Date:2017-12-15
Provider Licenses
StateLicense IDTaxonomies
NY666556163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse