Healthcare Provider Details

I. General information

NPI: 1336696111
Provider Name (Legal Business Name): LUCIANA ABRAHAMSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4087
US

IV. Provider business mailing address

1932 ONEAL AVE
PUEBLO CO
81004-5229
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-7162
  • Fax:
Mailing address:
  • Phone: 719-214-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1641811
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: