Provider Demographics
NPI:1396417572
Name:ABRAHAM, ALISSA MARIE (DNP, APRN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DNP, APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 EVANSTON WAY
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5349
Mailing Address - Country:US
Mailing Address - Phone:651-726-4676
Mailing Address - Fax:
Practice Address - Street 1:5005 EVANSTON WAY
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5349
Practice Address - Country:US
Practice Address - Phone:651-726-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30035363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health