Basic Information
| Provider Information | |||||||||
| NPI: | 1659823672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABBOTT | ||||||||
| FirstName: | VERNEVA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | ABBOTT | ||||||||
| OtherFirstName: | VERNEVA | ||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 269 S WESTERN AVE UNIT D | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900044103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057107997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 720 WOOD ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072682990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2016 | ||||||||
| LastUpdateDate: | 05/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 759286 | CA | N | Nursing Service Providers | Registered Nurse | 163WP0200X | 759286 | CA | N | Nursing Service Providers | Registered Nurse | Pediatrics | 163WP0808X | 759286 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.