Healthcare Provider Details

I. General information

NPI: 1710446133
Provider Name (Legal Business Name): SAMANTHA ABBADE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20601 WEST PAOLI LANE
WEIMAR CA
95736
US

IV. Provider business mailing address

501 FAIR MEADOWS BLVD
HAGERSTOWN MD
21740-6780
US

V. Phone/Fax

Practice location:
  • Phone: 530-296-4417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR194825
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: