Healthcare Provider Details

I. General information

NPI: 1912051046
Provider Name (Legal Business Name): JERLENE S. ABRAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KRAMER RD
DAYTON OH
45419-3311
US

IV. Provider business mailing address

415 KRAMER RD
DAYTON OH
45419-3311
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-2298
  • Fax: 937-299-7558
Mailing address:
  • Phone: 937-299-2298
  • Fax: 937-299-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN 142866
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: