MEDICARE: FABIENNE BLANC LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	PN5218427	FL

General Provider Information

NPI Number	:	1215475041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIENNE BLANC LPN

Provider Business Mailing Address
First Line	:	1001 NEW PARKVIEW PL
Second Line	:
City	:	HAVERHILL
State	:	FL
Zip	:	33417-5836
Country	:	US
Telephone Number	:	561-523-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	4170 BEAR LAKES CT
Second Line	:	APT 304 BLDG 7
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7745
Country	:	US
Telephone Number	:	561-523-4709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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