Healthcare Provider Details

I. General information

NPI: 1174445001
Provider Name (Legal Business Name): ABIGAIL ROGAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 GENESEE ST
UTICA NY
13502-4852
US

IV. Provider business mailing address

15 TINDALL MNR
CLINTON NY
13323-2003
US

V. Phone/Fax

Practice location:
  • Phone: 315-801-7140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: