Provider Demographics
NPI:1245509322
Name:FABIANO, MARY-NOELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY-NOELLE
Middle Name:
Last Name:FABIANO
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 1:50 WOODBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-1317
Mailing Address - Country:US
Mailing Address - Phone:518-392-1530
Mailing Address - Fax:
Practice Address - Street 1:50 WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1317
Practice Address - Country:US
Practice Address - Phone:518-392-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY437816163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool