Provider Demographics
NPI:1194206490
Name:ABRAHAM, GLORY (NP)
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 NORMANDY ST
Mailing Address - Street 2:STE 114
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3441
Mailing Address - Country:US
Mailing Address - Phone:734-474-6392
Mailing Address - Fax:
Practice Address - Street 1:4138 SCENIC VALLEY LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2192
Practice Address - Country:US
Practice Address - Phone:734-474-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily