Healthcare Provider Details

I. General information

NPI: 1245846963
Provider Name (Legal Business Name): ABIGAIL ELIZABETH MCINTOSH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 12/03/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N FIRST AVE
EVANSVILLE IN
47710-1218
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-4066
  • Fax: 812-450-3886
Mailing address:
  • Phone: 812-450-4066
  • Fax: 812-450-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28209562A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71010596A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: