Healthcare Provider Details

I. General information

NPI: 1245036417
Provider Name (Legal Business Name): ABIGAIL ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 COLORADO AVE
ALLIANCE NE
69301-2830
US

IV. Provider business mailing address

PO BOX 240
ALLIANCE NE
69301-0240
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-7520
  • Fax:
Mailing address:
  • Phone: 308-760-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: