Provider Demographics
NPI:1548404403
Name:ABRAHAM, ANJU (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANJU
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E STACY RD
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8756
Mailing Address - Country:US
Mailing Address - Phone:469-342-2005
Mailing Address - Fax:
Practice Address - Street 1:150 E STACY RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8756
Practice Address - Country:US
Practice Address - Phone:469-342-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX714056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily