Healthcare Provider Details

I. General information

NPI: 1134991615
Provider Name (Legal Business Name): ABIGAIL PATRICIA RICKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HOPPER RD
ACTON ME
04001-5803
US

IV. Provider business mailing address

81 HOPPER RD
ACTON ME
04001-5803
US

V. Phone/Fax

Practice location:
  • Phone: 207-468-0126
  • Fax:
Mailing address:
  • Phone: 207-468-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008752
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: