Provider Demographics
NPI:1194389189
Name:ABRAM, TIFFANY R (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:ABRAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 COLEGROVE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-6251
Mailing Address - Country:US
Mailing Address - Phone:720-495-1036
Mailing Address - Fax:
Practice Address - Street 1:4105 COLEGROVE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-6251
Practice Address - Country:US
Practice Address - Phone:720-495-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP-57841164W00000X
HILPN-19247164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse