Provider Demographics
NPI:1366053332
Name:ABANDO, ELIZABETH (RN, IBCLC, FNP-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ABANDO
Suffix:
Gender:F
Credentials:RN, IBCLC, FNP-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BASAN
Other - Last Name:ISIDOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3600 JOSEPH SIEWICK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1709
Mailing Address - Country:US
Mailing Address - Phone:703-391-3908
Mailing Address - Fax:
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187817363LX0001X
VAL-17597163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology