Provider Demographics
NPI:1689059529
Name:ABELLA, VINCENT (LPN)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:ABELLA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 N VALENCIA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5061
Mailing Address - Country:US
Mailing Address - Phone:480-351-9375
Mailing Address - Fax:
Practice Address - Street 1:43 N VALENCIA PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5061
Practice Address - Country:US
Practice Address - Phone:480-351-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP050813164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse