Healthcare Provider Details

I. General information

NPI: 1538795935
Provider Name (Legal Business Name): ABIGAIL ROSE REZENDES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 COLUMBIA RD
DORCHESTER MA
02125-2424
US

IV. Provider business mailing address

415 COLUMBIA RD
DORCHESTER MA
02125-2424
US

V. Phone/Fax

Practice location:
  • Phone: 617-287-8000
  • Fax:
Mailing address:
  • Phone: 617-287-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2339762
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2339762
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: