Provider Demographics
NPI:1912023292
Name:LEAVITT, ABIGAIL (RN, LMT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 UNION ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2433
Mailing Address - Country:US
Mailing Address - Phone:207-595-2413
Mailing Address - Fax:
Practice Address - Street 1:75 UNION ST APT 3
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2433
Practice Address - Country:US
Practice Address - Phone:207-595-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER04941163W00000X
MERN49491163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4323013999Medicaid