Healthcare Provider Details

I. General information

NPI: 1770262156
Provider Name (Legal Business Name): ABIGAIL ABBS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17321 ST RD 23
SOUTH BEND IN
46635-1531
US

IV. Provider business mailing address

707 CEDAR ST STE 405
SOUTH BEND IN
46617-2059
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-8400
  • Fax: 574-335-0796
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014364A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: