Provider Demographics
NPI:1043776511
Name:ABANILLA, ELIBEL MARIE
Entity Type:Individual
Prefix:
First Name:ELIBEL
Middle Name:MARIE
Last Name:ABANILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA ELIBEL
Other - Middle Name:VALERO
Other - Last Name:BEJERANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-722-7287
Practice Address - Street 1:354 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1754
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-722-7287
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001762363LF0000X
MARN2352375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily