Basic Information
| Provider Information | |||||||||
| NPI: | 1891306726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FABIANO | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 FORMAN AVE | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT BEACH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087423235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458031615 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 424 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FORKED RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087314654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099713500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2020 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NR21157800 | NJ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.