Healthcare Provider Details

I. General information

NPI: 1063262665
Provider Name (Legal Business Name): ABIEMWENSE SANDRA ABRAHAM DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20550 S LAGRANGE RD STE 11
FRANKFORT IL
60423-1699
US

IV. Provider business mailing address

20550 S LAGRANGE RD STE 11
FRANKFORT IL
60423-1699
US

V. Phone/Fax

Practice location:
  • Phone: 815-277-2035
  • Fax: 464-222-3721
Mailing address:
  • Phone: 708-262-8386
  • Fax: 464-222-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-029236
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.029236
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: