Provider Demographics
NPI:1417023151
Name:ABOLNAR, PAULINE MARIE (ANP FNP NURSE PRACTI)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:MARIE
Last Name:ABOLNAR
Suffix:
Gender:F
Credentials:ANP FNP NURSE PRACTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AMBROSE LANE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768
Mailing Address - Country:US
Mailing Address - Phone:631-261-0258
Mailing Address - Fax:
Practice Address - Street 1:189 WHEATLY RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-686-4400
Practice Address - Fax:516-686-4425
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRN414664163W00000X
NY301806ANP363LA2200X
NYFNP332903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00305592OtherRAILROAD MEDICARE
Q56309Medicare UPIN
P00305592OtherRAILROAD MEDICARE