Provider Demographics
NPI:1275074403
Name:ABRAHAM, BIBIN (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:BIBIN
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SILVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6784
Mailing Address - Country:US
Mailing Address - Phone:817-703-4373
Mailing Address - Fax:
Practice Address - Street 1:101 SILVERWOOD DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6784
Practice Address - Country:US
Practice Address - Phone:817-703-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN143859163W00000X
TX786780163W00000X
TXAP134418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse