Provider Demographics
NPI:1215475041
Name:BLANC, FABIENNE (LPN)
Entity type:Individual
Prefix:
First Name:FABIENNE
Middle Name:
Last Name:BLANC
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 1:1001 NEW PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5836
Mailing Address - Country:US
Mailing Address - Phone:561-523-4709
Mailing Address - Fax:
Practice Address - Street 1:4170 BEAR LAKES CT
Practice Address - Street 2:APT 304 BLDG 7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-7745
Practice Address - Country:US
Practice Address - Phone:561-523-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5218427251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health