Provider Demographics
NPI:1396419800
Name:LUITEL, ABINA
Entity Type:Individual
Prefix:
First Name:ABINA
Middle Name:
Last Name:LUITEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LIBERTY ST SE STE 170
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4149
Mailing Address - Country:US
Mailing Address - Phone:815-578-6109
Mailing Address - Fax:
Practice Address - Street 1:960 LIBERTY ST SE STE 170
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4149
Practice Address - Country:US
Practice Address - Phone:815-578-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052248363LF0000X
OR10003790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily