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General NPI Number Information
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NPI Number | 1114518644
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Entity Type | Individual
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Provider Name | ABIE SANDY NP
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Gender | Female
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Dates
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Enumeration Date | 01/28/2021
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 4400 CAPITOLA RD STE 200
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City | CAPITOLA
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State | CA
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Zip | 95010-3571
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Country | US
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Telephone | 831-426-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 BONINO WAY
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City | GILROY
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State | CA
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Zip | 95020
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Country | US
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Telephone | 408-569-8752
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95016146
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License Number State | CA
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