Healthcare Provider Details

I. General information

NPI: 1063897288
Provider Name (Legal Business Name): KIONIE ABRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRANSAM PLAZA DR STE 410
OAKBROOK TERRACE IL
60181-4290
US

IV. Provider business mailing address

121 FAIRFIELD WAY STE 207
BLOOMINGDALE IL
60108-1559
US

V. Phone/Fax

Practice location:
  • Phone: 866-259-1631
  • Fax: 855-618-2629
Mailing address:
  • Phone: 630-529-7427
  • Fax: 630-529-9937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-012812
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: