Healthcare Provider Details

I. General information

NPI: 1104672302
Provider Name (Legal Business Name): ABRAG NASSAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

315 MERRICK AVE
SUNNYSIDE WA
98944-2035
US

V. Phone/Fax

Practice location:
  • Phone: 509-840-0729
  • Fax:
Mailing address:
  • Phone: 509-840-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: