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General NPI Number Information
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NPI Number | 1154284107
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Entity Type | Organization
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Legal Business Name | ABILAIMAH
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Dates
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Enumeration Date | 12/06/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 1031 BROAD LAKE DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22406-7310
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Country | US
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Telephone | 703-975-0942
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 BROAD LAKE DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22406-7310
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Country | US
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Telephone | 703-975-0942
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | YAMA BUNDU
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Credential |
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Telephone | 703-975-0942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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