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General NPI Number Information
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NPI Number | 1053620443
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Entity Type | Individual
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Provider Name | ABIGAIL DRAKE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2010
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Last Update Date | 10/02/2010
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Provider Practice Location Address
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Address Line | 4250 DEMPSTER ST
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City | SKOKIE
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State | IL
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Zip | 60076-2008
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Country | US
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Telephone | 847-763-8850
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Fax | 847-763-8851
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Provider Business Mailing Address
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Address Line | 1030 SCHOOL RD
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City | CAMBRIDGE
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State | VT
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Zip | 05444-9520
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Country | US
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Telephone | 720-202-5530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085002790
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3063
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License Number State | CO
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