Healthcare Provider Details

I. General information

NPI: 1770073629
Provider Name (Legal Business Name): ABIGAIL JANICE CUDNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E STATE ST STE G100
SAINT JOHNS MI
48879-1571
US

IV. Provider business mailing address

100 E STATE ST STE G100
SAINT JOHNS MI
48879-1571
US

V. Phone/Fax

Practice location:
  • Phone: 989-224-5251
  • Fax:
Mailing address:
  • Phone: 989-224-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802080443
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: