Provider Demographics
NPI:1043616832
Name:ABREU, ELBA (139362)
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:
Last Name:ABREU
Suffix:
Gender:F
Credentials:139362
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7931 W. UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209
Mailing Address - Country:US
Mailing Address - Phone:316-305-3412
Mailing Address - Fax:316-425-8181
Practice Address - Street 1:7931 W. UNIVERSITY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2031
Practice Address - Country:US
Practice Address - Phone:316-305-3412
Practice Address - Fax:316-425-8181
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB087207385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK00-60-3260OtherDL