Provider Demographics
NPI:1831871896
Name:STUBBLEFIELD, ABIGAIL GRACE
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:GRACE
Last Name:STUBBLEFIELD
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 1:14745 JENNIFER CT
Mailing Address - Street 2:
Mailing Address - City:SWAN POINT
Mailing Address - State:MD
Mailing Address - Zip Code:20645-2104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14745 JENNIFER CT
Practice Address - Street 2:
Practice Address - City:SWAN POINT
Practice Address - State:MD
Practice Address - Zip Code:20645-2104
Practice Address - Country:US
Practice Address - Phone:678-350-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291278163W00000X
MDAC005822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse