Provider Demographics
NPI:1790829695
Name:ABU, MATENNEH
Entity Type:Individual
Prefix:
First Name:MATENNEH
Middle Name:
Last Name:ABU
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 1:7248 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-1533
Mailing Address - Country:US
Mailing Address - Phone:267-292-2647
Mailing Address - Fax:267-292-2657
Practice Address - Street 1:7248 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-1533
Practice Address - Country:US
Practice Address - Phone:267-292-2647
Practice Address - Fax:267-292-2657
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10025660163WS0200X
PARN515514L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool