=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891053690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETH ABATE NURSE PRACTITIONER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2012
-----------------------------------------------------
Last Update Date | 08/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6910 MAYFAIR RD
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20707-5237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-447-9995
-----------------------------------------------------
Fax | 301-776-0087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6910 MAYFAIR RD
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20707-5237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-447-9995
-----------------------------------------------------
Fax | 301-776-0087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | BETELEHAM ABATE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-447-9995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------