Healthcare Provider Details

I. General information

NPI: 1053894238
Provider Name (Legal Business Name): ABIGAYL FRIELDS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ILLINOIS RT 2
DIXON IL
61021-9118
US

IV. Provider business mailing address

325 ILLINOIS RT 2
DIXON IL
61021-9118
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-6611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.018576
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018576
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: