Provider Demographics
NPI:1447615430
Name:FLAGG, ABIGAIL STARKEY (LPN)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:STARKEY
Last Name:FLAGG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 DORCHESTER AVE
Mailing Address - Street 2:APT. 1B
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1419
Mailing Address - Country:US
Mailing Address - Phone:315-399-7918
Mailing Address - Fax:
Practice Address - Street 1:208 DORCHESTER AVE
Practice Address - Street 2:APT. 1B
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1419
Practice Address - Country:US
Practice Address - Phone:315-399-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290963-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse