Healthcare Provider Details

I. General information

NPI: 1194587469
Provider Name (Legal Business Name): ABIGAIL MARIE SIROIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL MARIE HAM-THOMPSON RN

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6795
US

IV. Provider business mailing address

428 TOGUS RD
CHELSEA ME
04330-1269
US

V. Phone/Fax

Practice location:
  • Phone: 207-441-9180
  • Fax:
Mailing address:
  • Phone: 207-441-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN79599
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: