Healthcare Provider Details

I. General information

NPI: 1750438859
Provider Name (Legal Business Name): ABIGAIL S BOSTON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 WALKER LAKE ONTARIO RD
HILTON NY
14468-9131
US

IV. Provider business mailing address

188 UTICA ST
BROCKPORT NY
14420-2235
US

V. Phone/Fax

Practice location:
  • Phone: 585-964-8971
  • Fax:
Mailing address:
  • Phone: 585-637-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2204171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: