Provider Demographics
NPI:1043776511
Name:ABANILLA, ELIBEL MARIE
Entity type:Individual
Prefix:
First Name:ELIBEL
Middle Name:MARIE
Last Name:ABANILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA ELIBEL
Other - Middle Name:VALERO
Other - Last Name:BEJERANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2937
Mailing Address - Country:US
Mailing Address - Phone:603-580-6753
Mailing Address - Fax:603-580-6840
Practice Address - Street 1:14A TSIENNETO ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-404-6800
Practice Address - Fax:603-686-7244
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001762363LF0000X
MARN2352375363LF0000X
NH091648-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily