Provider Demographics
NPI:1679900195
Name:ABDAGIC, EDIN (NP)
Entity Type:Individual
Prefix:
First Name:EDIN
Middle Name:
Last Name:ABDAGIC
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ELM ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4538
Mailing Address - Country:US
Mailing Address - Phone:702-690-1633
Mailing Address - Fax:
Practice Address - Street 1:343 ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4538
Practice Address - Country:US
Practice Address - Phone:702-690-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-29
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041371933163W00000X
IL209015952363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV821574OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS