Healthcare Provider Details

I. General information

NPI: 1801441530
Provider Name (Legal Business Name): ABIGAIL CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 SHARLANDS AVE
RENO NV
89523-2785
US

IV. Provider business mailing address

5975 S LOS ALTOS PKWY
SPARKS NV
89436-7699
US

V. Phone/Fax

Practice location:
  • Phone: 775-204-4000
  • Fax: 775-234-4605
Mailing address:
  • Phone: 775-204-4000
  • Fax: 775-234-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2151
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: