Healthcare Provider Details

I. General information

NPI: 1043025307
Provider Name (Legal Business Name): ABIGAIL LAUREN MCDERMOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10806 MONROE RD
MATTHEWS NC
28105-7305
US

IV. Provider business mailing address

536 W TREMONT AVE APT 551
CHARLOTTE NC
28203-6974
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2947
  • Fax:
Mailing address:
  • Phone: 717-495-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2390278
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5022747
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: