Provider Demographics
NPI:1710167697
Name:ABERNATHY, ADRIENNE (MLT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 KENMORE AVE APT 921
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1224
Mailing Address - Country:US
Mailing Address - Phone:571-232-9465
Mailing Address - Fax:
Practice Address - Street 1:4701 KENMORE AVE APT 921
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1224
Practice Address - Country:US
Practice Address - Phone:571-232-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ELGIBLE246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory