Basic Information
| Provider Information | |||||||||
| NPI: | 1538892740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALZELL | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 CUMBERLAND ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040111933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077518361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4 CLEMENT WAY # 27 | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049174370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2022 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CNP221329 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163WP2201X | RN77634 | ME | N | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No ID Information.