Healthcare Provider Details

I. General information

NPI: 1992077127
Provider Name (Legal Business Name): ABIGAIL WOLAVER RN, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL DAVENPORT NP-C

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CAMINO DE LOS CABALLOS
SANTA FE NM
87507-9494
US

IV. Provider business mailing address

2921 CAMINO DE LOS CABALLOS
SANTA FE NM
87507-9494
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-1600
  • Fax:
Mailing address:
  • Phone: 505-467-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-01952
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR57700
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: