Healthcare Provider Details

I. General information

NPI: 1952178444
Provider Name (Legal Business Name): ABIGAIL SEVERINO PALENZUELA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SIERRA PL NE
ALBUQUERQUE NM
87108-1137
US

IV. Provider business mailing address

202 SIERRA PL NE
ALBUQUERQUE NM
87108-1137
US

V. Phone/Fax

Practice location:
  • Phone: 415-756-6462
  • Fax:
Mailing address:
  • Phone: 415-756-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76951
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: