Provider Demographics
NPI:1457773749
Name:FABIANO, CHARLENE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:FABIANO
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LINCOLN AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1751
Mailing Address - Country:US
Mailing Address - Phone:812-867-9355
Mailing Address - Fax:
Practice Address - Street 1:2801 LINCOLN AVE STE B3
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1751
Practice Address - Country:US
Practice Address - Phone:812-867-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000153A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist