Healthcare Provider Details

I. General information

NPI: 1174085484
Provider Name (Legal Business Name): ABIGAIL ANN WHITTEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2682 E GRAND RIVER AVE
EAST LANSING MI
48823-5608
US

IV. Provider business mailing address

2689 NARROW LAKE RD
CHARLOTTE MI
48813-9167
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-6562
  • Fax:
Mailing address:
  • Phone: 517-749-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11180838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: