Healthcare Provider Details

I. General information

NPI: 1972267482
Provider Name (Legal Business Name): ABIGAIL CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 NEW BERN AVE STE 160
RALEIGH NC
27610-1552
US

IV. Provider business mailing address

3209 DOUGLAS FIR RD
RALEIGH NC
27616-4014
US

V. Phone/Fax

Practice location:
  • Phone: 919-556-1008
  • Fax: 919-556-6099
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10211191
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: