Healthcare Provider Details

I. General information

NPI: 1326183773
Provider Name (Legal Business Name): BEKA LORAINE ABRAHAM C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE 3200
DAYTON OH
45409-2939
US

IV. Provider business mailing address

1059 GLENHOLLOW CT
FAIRBORN OH
45324-9234
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2325
  • Fax: 937-208-2014
Mailing address:
  • Phone: 937-879-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP08991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: