Healthcare Provider Details

I. General information

NPI: 1396582938
Provider Name (Legal Business Name): ABAGAIL HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

IV. Provider business mailing address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

V. Phone/Fax

Practice location:
  • Phone: 716-664-8120
  • Fax: 716-664-8337
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033729-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: