Provider Demographics
NPI:1902066384
Name:GABRICK, ABIGALE E (PAC)
Entity Type:Individual
Prefix:
First Name:ABIGALE
Middle Name:E
Last Name:GABRICK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ABIAGLE
Other - Middle Name:E
Other - Last Name:JEFFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:5803 NEAL AVE N
Mailing Address - Street 2:OAK PARK HEIGHTS
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2177
Mailing Address - Country:US
Mailing Address - Phone:651-439-8807
Mailing Address - Fax:651-439-0232
Practice Address - Street 1:5803 NEAL AVE N
Practice Address - Street 2:OAK PARK HEIGHTS
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-2177
Practice Address - Country:US
Practice Address - Phone:651-439-8807
Practice Address - Fax:651-439-0232
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2318363A00000X
MN10464363A00000X
WI2318-23363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI56080-0040Medicare PIN
MN970003540Medicare PIN
WI49128-0040Medicare PIN
WI43022300Medicaid
MN1902066384Medicaid