=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679351936
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER M ABRAHAM RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2023
-----------------------------------------------------
Last Update Date | 07/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 MOONLIGHT DR
-----------------------------------------------------
City | BEREA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40403-9239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-858-4761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 MOONLIGHT DR
-----------------------------------------------------
City | BEREA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40403-9239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-452-0354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0000X
-----------------------------------------------------
Taxonomy Name | Pain Management Registered Nurse
-----------------------------------------------------
License Number | RN6910899
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | RN6910899
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | 4031876
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | RN6910899
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 163WC3500X
-----------------------------------------------------
Taxonomy Name | Cardiac Rehabilitation Registered Nurse
-----------------------------------------------------
License Number | RN6910899
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 163WG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Registered Nurse
-----------------------------------------------------
License Number | RN6910899
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 4031876
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------