Provider Demographics
NPI:1942788260
Name:FAIRBANKS, TREBLA K (LVN)
Entity Type:Individual
Prefix:
First Name:TREBLA
Middle Name:K
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22506 RAINFERN DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-6262
Mailing Address - Country:US
Mailing Address - Phone:281-701-2312
Mailing Address - Fax:
Practice Address - Street 1:22506 RAINFERN DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-6262
Practice Address - Country:US
Practice Address - Phone:281-701-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141490164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse