Healthcare Provider Details

I. General information

NPI: 1811689144
Provider Name (Legal Business Name): DOUGLAS JOHAN ABRAHAM APRN, FNP-C, ENP-C,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MICHIGAN AVE W STE 201
BATTLE CREEK MI
49017-3621
US

IV. Provider business mailing address

PO BOX 670
BATTLE CREEK MI
49016-0670
US

V. Phone/Fax

Practice location:
  • Phone: 269-282-9022
  • Fax: 844-332-3887
Mailing address:
  • Phone: 269-282-9022
  • Fax: 844-332-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704341949
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3282482
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number52167
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number90980
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number52167
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number52167
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: