Provider Demographics
NPI:1255150355
Name:ABELL, GREG WILLIAM
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:WILLIAM
Last Name:ABELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:WILLIAM
Other - Last Name:ABELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BIRTH CERTIFICATE
Mailing Address - Street 1:935 SPRING ST # B
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4543
Mailing Address - Country:US
Mailing Address - Phone:530-967-8907
Mailing Address - Fax:
Practice Address - Street 1:935B SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4523
Practice Address - Country:US
Practice Address - Phone:530-967-8907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA794332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse