Provider Demographics
NPI:1154899144
Name:ABEBIO, FAUSTINA OWUSU
Entity type:Individual
Prefix:
First Name:FAUSTINA
Middle Name:OWUSU
Last Name:ABEBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2032
Mailing Address - Country:US
Mailing Address - Phone:240-463-4517
Mailing Address - Fax:
Practice Address - Street 1:1 PLAINVIEW DR
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2032
Practice Address - Country:US
Practice Address - Phone:860-367-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2023-04-06
Deactivation Date:2018-11-08
Deactivation Code:
Reactivation Date:2018-11-21
Provider Licenses
StateLicense IDTaxonomies
CTHCA0001487376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT832193222Medicaid