Healthcare Provider Details

I. General information

NPI: 1659057131
Provider Name (Legal Business Name): ABIGAIL REIBER HENDERSON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 UPPER PLN
BRADFORD VT
05033-9207
US

IV. Provider business mailing address

239 HAWLEY LN
RUTLAND VT
05701-8979
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-4722
  • Fax:
Mailing address:
  • Phone: 802-236-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number101.0136325
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number101.0136325
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: