1780795450 NPI number — MRS. ANGELA MARIE ABDI MSN,FNP,BC

Table of content: AMBER SHADD-PATTERSON (NPI 1225684624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780795450 NPI number — MRS. ANGELA MARIE ABDI MSN,FNP,BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDI
Provider First Name:
ANGELA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN,FNP,BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABDI
Provider Other First Name:
ANGELA
Provider Other Middle Name:
SURFACE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN,FNP,BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780795450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 ELM HILL PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37214-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
187-785-2267
Provider Business Mailing Address Fax Number:
615-425-4201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 ELM HILL PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37214-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
187-785-2267
Provider Business Practice Location Address Fax Number:
615-425-4201
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN0000104084 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN7149 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN0001128527 . This is a "LICENSE NUMBER RN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7781792 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103I502213 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000118475 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1522336 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP0024128527 . This is a "NURSE PRACTITIONER LICENS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: APN0000007149 . This is a "ADVANCED PRACTICE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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