Provider Demographics
NPI:1447869540
Name:LAITAN, ABBY DALE (NP)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:DALE
Last Name:LAITAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 LOUIS PASTEUR DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4019
Mailing Address - Country:US
Mailing Address - Phone:210-610-3859
Mailing Address - Fax:210-641-2277
Practice Address - Street 1:7622 LOUIS PASTEUR DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4019
Practice Address - Country:US
Practice Address - Phone:210-610-3859
Practice Address - Fax:210-641-2277
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX915368163W00000X
TX1018214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse