Healthcare Provider Details

I. General information

NPI: 1679351936
Provider Name (Legal Business Name): PETER M ABRAHAM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MOONLIGHT DR
BEREA KY
40403-9239
US

IV. Provider business mailing address

1000 MOONLIGHT DR
BEREA KY
40403-9239
US

V. Phone/Fax

Practice location:
  • Phone: 610-858-4761
  • Fax:
Mailing address:
  • Phone: 859-452-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN6910899
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN6910899
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number4031876
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN6910899
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License NumberRN6910899
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN6910899
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4031876
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: