Provider Demographics
NPI:1649426040
Name:ERICKSON, ABIGAIL ELIZABETH (PHYSICIAN ASSISTANT-)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:ELIZABETH
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT-
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:ELIZABETH
Other - Last Name:GJELDUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT-
Mailing Address - Street 1:332 WEST LEE HIGHWAY
Mailing Address - Street 2:#97
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:630-254-1014
Mailing Address - Fax:
Practice Address - Street 1:1840 AMHERST STREET
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-536-8708
Practice Address - Fax:540-536-4177
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104677363AS0400X, 364SN0800X
363AM0700X
VA0110003999364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscience