Provider Demographics
NPI:1336617687
Name:SCHULTZ, ABIGAIL KIENZLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:KIENZLE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:HALL
Other - Last Name:KIENZLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1815 JOHN F KENNEDY BLVD APT 2809
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1724
Mailing Address - Country:US
Mailing Address - Phone:610-405-2460
Mailing Address - Fax:
Practice Address - Street 1:1218 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2616
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-216-3854
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily