Provider Demographics
NPI:1134991615
Name:RICKARD, ABIGAIL PATRICIA
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:PATRICIA
Last Name:RICKARD
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 1:81 HOPPER RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:ME
Mailing Address - Zip Code:04001-5803
Mailing Address - Country:US
Mailing Address - Phone:207-468-0126
Mailing Address - Fax:
Practice Address - Street 1:81 HOPPER RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:ME
Practice Address - Zip Code:04001-5803
Practice Address - Country:US
Practice Address - Phone:207-468-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008752133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered