Provider Demographics
NPI:1932895075
Name:FABIA, QUEEN (LVN)
Entity Type:Individual
Prefix:MS
First Name:QUEEN
Middle Name:
Last Name:FABIA
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 1:2750 PINOLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1425
Mailing Address - Country:US
Mailing Address - Phone:510-222-9422
Mailing Address - Fax:
Practice Address - Street 1:2750 PINOLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1425
Practice Address - Country:US
Practice Address - Phone:510-222-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN186392164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse