Basic Information
| Provider Information | |||||||||
| NPI: | 1942958525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABATE | ||||||||
| FirstName: | MACKENZIE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 N BROAD STREET ROOM 001A | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191404106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269022 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3322 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157071800 | ||||||||
| FaxNumber: | 2157073644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2022 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP024345 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.