Healthcare Provider Details

I. General information

NPI: 1174350946
Provider Name (Legal Business Name): ABBIE LEE CANO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N BRYAN ST
BORGER TX
79007-4010
US

IV. Provider business mailing address

8775 COUNTY LINE RD
FRITCH TX
79036-8179
US

V. Phone/Fax

Practice location:
  • Phone: 806-274-3627
  • Fax: 806-274-9176
Mailing address:
  • Phone: 806-440-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1175161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: