Provider Demographics
NPI:1750438859
Name:BOSTON, ABIGAIL S (RN)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:S
Last Name:BOSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2235
Mailing Address - Country:US
Mailing Address - Phone:585-637-3818
Mailing Address - Fax:
Practice Address - Street 1:709 WALKER LAKE ONTARIO RD
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-9131
Practice Address - Country:US
Practice Address - Phone:585-964-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2204171163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02501348Medicaid