Provider Demographics
NPI:1598109910
Name:ST LOUIS, FABIOLA CADET (FNP-BC)
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:CADET
Last Name:ST LOUIS
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:FABIOLA
Other - Middle Name:ST
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:736 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1145
Mailing Address - Country:US
Mailing Address - Phone:347-879-4029
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31363-1164W00000X
NY313633-1261Q00000X
NY356228363LF0000X
FL11037383363LF0000X
NY738900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No163W00000XNursing Service ProvidersRegistered Nurse