Provider Demographics
NPI:1023761970
Name:ABBAN, AMELIA (CRNP-BC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:ABBAN
Suffix:
Gender:F
Credentials:CRNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15613 MEWS CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3307
Mailing Address - Country:US
Mailing Address - Phone:301-776-2551
Mailing Address - Fax:
Practice Address - Street 1:14502 GREENVIEW DR STE 500L21
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3287
Practice Address - Country:US
Practice Address - Phone:240-473-3007
Practice Address - Fax:949-695-2194
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD221285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine