Provider Demographics
NPI:1760185110
Name:BINETTE, ABIGAIL MCKENNA
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MCKENNA
Last Name:BINETTE
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 1:10281 NUMAGA RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-4024
Mailing Address - Country:US
Mailing Address - Phone:702-587-4734
Mailing Address - Fax:
Practice Address - Street 1:10281 NUMAGA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-4024
Practice Address - Country:US
Practice Address - Phone:702-587-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer