Healthcare Provider Details

I. General information

NPI: 1083016646
Provider Name (Legal Business Name): IRENE MARY ABUAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 WEST TUNNEL ST.
SANTA MARIA CA
93458-4096
US

IV. Provider business mailing address

117 WEST TUNNEL STREET
SANTA MARIA CA
93458
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax: 805-614-0179
Mailing address:
  • Phone: 805-614-4940
  • Fax: 805-614-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number779131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: