Provider Demographics
NPI:1801557061
Name:PRUSHANSKY, ABIGAIL G (FNP-BC, CNM)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:G
Last Name:PRUSHANSKY
Suffix:
Gender:F
Credentials:FNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD STE 480
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4588
Mailing Address - Country:US
Mailing Address - Phone:424-309-1461
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD STE 480
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4588
Practice Address - Country:US
Practice Address - Phone:424-309-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019642363LF0000X
CA236450367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily