Provider Demographics
NPI:1740832344
Name:FABRE, JANELLE ALEXANDRA (LPN)
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:ALEXANDRA
Last Name:FABRE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5229
Mailing Address - Country:US
Mailing Address - Phone:203-832-9867
Mailing Address - Fax:
Practice Address - Street 1:154 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5229
Practice Address - Country:US
Practice Address - Phone:203-832-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40549164W00000X
NY322788164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse