Provider Demographics
NPI:1326630096
Name:WILSON, ABIGAIL NAOMI (NP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:NAOMI
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 GILMORE RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9313
Mailing Address - Country:US
Mailing Address - Phone:585-481-7215
Mailing Address - Fax:
Practice Address - Street 1:362 GILMORE RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-9313
Practice Address - Country:US
Practice Address - Phone:585-481-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310137363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner