Provider Demographics
NPI:1467728717
Name:ABRAHAM, GRACE CLYNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:CLYNE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 FLATBUSH AVE
Mailing Address - Street 2:APT. 6E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4966
Mailing Address - Country:US
Mailing Address - Phone:718-856-4756
Mailing Address - Fax:
Practice Address - Street 1:237 7TH AVENUE
Practice Address - Street 2:SECONDARY SCHOOL FOR JOURNALISM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-832-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423324-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program