Provider Demographics
NPI:1366319253
Name:BLACKMORE, ABIGAIL RUTH (MSN, RN TCRN)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:RUTH
Last Name:BLACKMORE
Suffix:
Gender:F
Credentials:MSN, RN TCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35580 ELK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-3757
Mailing Address - Country:US
Mailing Address - Phone:800-800-1520
Mailing Address - Fax:
Practice Address - Street 1:33456 HAVLIK DR
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3836
Practice Address - Country:US
Practice Address - Phone:800-800-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7160396163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse