Basic Information
Provider Information
NPI: 1053767335
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONCON
FirstName: ABEGAIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2820 W CHARLESTON BLVD
Address2: 33
City: LAS VEGAS
State: NV
PostalCode: 891021942
CountryCode: US
TelephoneNumber: 7028801558
FaxNumber: 7028706821
Practice Location
Address1: 2820 W CHARLESTON BLVD
Address2: 33
City: LAS VEGAS
State: NV
PostalCode: 891021942
CountryCode: US
TelephoneNumber: 7028801558
FaxNumber: 7028706821
Other Information
ProviderEnumerationDate: 05/05/2016
LastUpdateDate: 08/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN002158NVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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