Provider Demographics
NPI:1811795008
Name:CLEARY, ABIGAIL COLLEEN (AGACNP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:COLLEEN
Last Name:CLEARY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CONGRESS ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2148
Mailing Address - Country:US
Mailing Address - Phone:207-774-5222
Mailing Address - Fax:207-761-4433
Practice Address - Street 1:1600 CONGRESS ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2148
Practice Address - Country:US
Practice Address - Phone:207-774-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP251061363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology