Healthcare Provider Details

I. General information

NPI: 1316357643
Provider Name (Legal Business Name): ABBY HUBBARD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY CUMMINGS

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 01/09/2024
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 W. TAFT RD. STE J
LIVERPOOL NY
13088
US

IV. Provider business mailing address

5112 W. TAFT RD. STE J
LIVERPOOL NY
13088
US

V. Phone/Fax

Practice location:
  • Phone: 315-701-2170
  • Fax:
Mailing address:
  • Phone: 315-701-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: