Healthcare Provider Details

I. General information

NPI: 1669656187
Provider Name (Legal Business Name): DONNA M AGAVE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA ABARBANEL APRN

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 SOUTH BEDFORD ST STE 400W
BURLINGTON MA
01803
US

IV. Provider business mailing address

67 SOUTH BEDFORD ST STE 400W
BURLINGTON MA
01803
US

V. Phone/Fax

Practice location:
  • Phone: 781-773-8200
  • Fax: 650-282-4462
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number149537
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number149537
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: