Healthcare Provider Details

I. General information

NPI: 1205445129
Provider Name (Legal Business Name): GERMAN AUGUSTO ABARCA-PAILLACHO DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7418 NE VILLAGE LN
PITTSBURG KS
66762-8568
US

IV. Provider business mailing address

7418 NE VILLAGE LN
PITTSBURG KS
66762-8568
US

V. Phone/Fax

Practice location:
  • Phone: 620-249-4818
  • Fax:
Mailing address:
  • Phone: 620-249-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79526-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: