Provider Demographics
NPI:1689328775
Name:DELISLE, ABIGAIL (PA-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:DELISLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 S LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2448
Mailing Address - Country:US
Mailing Address - Phone:218-230-9107
Mailing Address - Fax:
Practice Address - Street 1:1505 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2448
Practice Address - Country:US
Practice Address - Phone:218-230-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant