Healthcare Provider Details

I. General information

NPI: 1003641283
Provider Name (Legal Business Name): ABIGAIL KOZHUHAROV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/11/2025
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

423 SILO RD
NEW CASTLE DE
19720-5643
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax:
Mailing address:
  • Phone: 443-350-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberLP-0010807
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: