Healthcare Provider Details

I. General information

NPI: 1235722109
Provider Name (Legal Business Name): ABIGAIL PATRICIA PLOMINSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE BLDG A
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

300 68TH ST SE BLDG A
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 800-678-5500
  • Fax: 616-455-5460
Mailing address:
  • Phone: 800-678-5500
  • Fax: 616-455-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: