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General NPI Number Information
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NPI Number | 1306117767
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Entity Type | Individual
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Provider Name | ANNAMMA ABRAHAM NP
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Gender | Female
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 110 E SCHILLER ST STE 319
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City | ELMHURST
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State | IL
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Zip | 60126-2823
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Country | US
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Telephone | 630-832-1775
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 CHESTERFIELD LN
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City | GRAYSLAKE
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State | IL
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Zip | 60030-3798
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Country | US
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Telephone | 847-231-5327
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.008789
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License Number State | IL
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