MEDICARE: MR. ARNOLD C ABELLERA APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209022786	IL
2	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1669061438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARNOLD C ABELLERA APRN, FNP-C

Provider Business Mailing Address
First Line	:	1478 WILLOW AVE -
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016
Country	:	US
Telephone Number	:	224-220-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	1478 WILLOW AVE -
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016
Country	:	US
Telephone Number	:	708-833-2410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	02/01/2021

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