MEDICARE: ABIGAIL GOODWIN SLADEK APRN,AGPCNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	14238915-4405	UT
2	363L00000X	Nurse Practitioner	GAA-NP003887	GA
3	363L00000X	Nurse Practitioner	303571	AZ
4	363L00000X	Nurse Practitioner	116648	NE
5	363L00000X	Nurse Practitioner	APN.0992151-NP	CO

General Provider Information

NPI Number	:	1205292653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL GOODWIN SLADEK APRN,AGPCNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 211699
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-3699
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:	888-973-8821

Provider Business Practice Location Address
First Line	:	1055 HOWELL MILL RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5557
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:	888-973-8821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	02/11/2026

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