Healthcare Provider Details

I. General information

NPI: 1700869054
Provider Name (Legal Business Name): LAUREN V ABELA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 S EASTERN AVE STE 110
LAS VEGAS NV
89183-7950
US

IV. Provider business mailing address

9975 S EASTERN AVE STE 110
LAS VEGAS NV
89183-7950
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-7208
  • Fax: 702-616-0657
Mailing address:
  • Phone: 702-492-7208
  • Fax: 702-616-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA753
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: