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NPI Code Detail

MEDICARE: ABIGAIL ANDERSON

MEDICARE: ABIGAIL ANDERSON
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
1363A00000XPhysician AssistantPA228848OR
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255141826
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL ANDERSON
Provider Business Mailing Address
First Line : 1515 VILLAGE DR
Second Line :
City : COTTAGE GROVE
State : OR
Zip : 97424-9700
Country : US
Telephone Number : 541-767-5222
Fax Number :
Provider Business Practice Location Address
First Line : 1775 N SECTOR CT STE 200
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-2859
Country : US
Telephone Number : 540-542-6208
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2025
Last Update Date : 02/11/2026

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Directions to “ ABIGAIL ANDERSON ” Practice Location

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