Healthcare Provider Details

I. General information

NPI: 1649426040
Provider Name (Legal Business Name): ABIGAIL ELIZABETH ERICKSON PHYSICIAN ASSISTANT-
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABIGAIL ELIZABETH GJELDUM PHYSICIAN ASSISTANT-

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST STREET EMERGENCY DEPARTMENT
WINCHESTER VA
22601
US

IV. Provider business mailing address

332 WEST LEE HIGHWAY #97
WARRENTON VA
20186
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-8708
  • Fax: 540-536-4177
Mailing address:
  • Phone: 630-254-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9104677
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License Number0110003999
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License NumberPA9104677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: