=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609116169
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FABIENNE PIERRE-ETIENNE LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2013
-----------------------------------------------------
Last Update Date | 02/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1430 BROADWAY FL 7
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10018-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-847-2977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 CLARKSON AVE APT 3H
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11226-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-789-1657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 300556-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------