Provider Demographics
NPI:1740086628
Name:HENDERSON, ABIGAIL MARIE (NP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE
Last Name:HENDERSON
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 1:7670 INSKIP TRL S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-2059
Mailing Address - Country:US
Mailing Address - Phone:651-380-8148
Mailing Address - Fax:
Practice Address - Street 1:683 BIELENBERG DR STE 103
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1711
Practice Address - Country:US
Practice Address - Phone:952-841-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2482591163WG0000X
WI1121914-30163WG0000X
WI17107-33363LF0000X
MN13170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice