MEDICARE: JENNIFER V ABRAHAM PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0004068	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194121657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER V ABRAHAM PA-C

Provider Business Mailing Address
First Line	:	3433 WARREN FARM DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6344
Country	:	US
Telephone Number	:	651-319-1563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 WARREN FARM DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6344
Country	:	US
Telephone Number	:	651-319-1563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	07/07/2015

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