Healthcare Provider Details

I. General information

NPI: 1740086628
Provider Name (Legal Business Name): ABIGAIL MARIE HENDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 BIELENBERG DR STE 103
WOODBURY MN
55125-1711
US

IV. Provider business mailing address

7670 INSKIP TRL S
COTTAGE GROVE MN
55016-2059
US

V. Phone/Fax

Practice location:
  • Phone: 952-841-2345
  • Fax:
Mailing address:
  • Phone: 651-380-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2482591
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1121914-30
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17107-33
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13170
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: