Healthcare Provider Details

I. General information

NPI: 1629523337
Provider Name (Legal Business Name): LELISSE ABATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

6909 MAYFAIR RD
LAUREL MD
20707-5236
US

V. Phone/Fax

Practice location:
  • Phone: 240-461-9199
  • Fax:
Mailing address:
  • Phone: 240-461-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN1003559
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: