Provider Demographics
NPI:1154726248
Name:OGLE, ABIGAIL (NP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:OGLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 E BROWNING AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6412
Mailing Address - Country:US
Mailing Address - Phone:901-496-0717
Mailing Address - Fax:
Practice Address - Street 1:7206 N MILBURN AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8450
Practice Address - Country:US
Practice Address - Phone:559-224-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007299363L00000X
NC273757363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3015Medicaid
NC1154726248Medicaid
NCNCL597AMedicare PIN