Healthcare Provider Details

I. General information

NPI: 1265722532
Provider Name (Legal Business Name): MYLENE ABUTIN AGNIR NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N WITCHDUCK RD STE F
VIRGINIA BEACH VA
23455
US

IV. Provider business mailing address

3649 STORM BIRD LOOP
VIRGINIA BEACH VA
23453-2258
US

V. Phone/Fax

Practice location:
  • Phone: 757-518-8810
  • Fax: 757-518-8825
Mailing address:
  • Phone: 757-368-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169349
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001160317
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: