Provider Demographics
NPI:1215272604
Name:ABEJUELA, IMELDA ESTIAMBA (RN)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:ESTIAMBA
Last Name:ABEJUELA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-413-7775
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE #101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-893-3333
Practice Address - Fax:702-413-7775
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRN63208163W00000X
NVRN63208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NV1702161Medicaid
NVGC779AMedicare PIN
NVCCN297191Medicare PIN
NVCCN294507Medicare PIN