Provider Demographics
NPI:1891595211
Name:MADANAT, ABAGAIL GRACE
Entity type:Individual
Prefix:
First Name:ABAGAIL
Middle Name:GRACE
Last Name:MADANAT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 DRIFTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1667
Mailing Address - Country:US
Mailing Address - Phone:623-209-9886
Mailing Address - Fax:
Practice Address - Street 1:627 DRIFTWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1667
Practice Address - Country:US
Practice Address - Phone:623-209-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.031683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily