Provider Demographics
NPI:1982236477
Name:BEYENE, ABENET BONGER (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:ABENET
Middle Name:BONGER
Last Name:BEYENE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1306
Mailing Address - Country:US
Mailing Address - Phone:484-784-8145
Mailing Address - Fax:
Practice Address - Street 1:126 N CEDAR LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1306
Practice Address - Country:US
Practice Address - Phone:484-784-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty