Provider Demographics
NPI:1407401474
Name:VOPAL, ABBY CHRISTINE
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:CHRISTINE
Last Name:VOPAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GRANITE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4563
Mailing Address - Country:US
Mailing Address - Phone:304-559-8559
Mailing Address - Fax:
Practice Address - Street 1:66 BRAMHALL ST FL 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3355
Practice Address - Country:US
Practice Address - Phone:207-662-6434
Practice Address - Fax:207-662-3157
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily