Provider Demographics
NPI:1578097200
Name:ABRAHAM, SOFI MERY (NP)
Entity Type:Individual
Prefix:
First Name:SOFI
Middle Name:MERY
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9451 HURON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5426
Mailing Address - Country:US
Mailing Address - Phone:303-650-4042
Mailing Address - Fax:
Practice Address - Street 1:9451 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-5426
Practice Address - Country:US
Practice Address - Phone:303-650-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993014-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1578097200Medicaid
CO876021OtherMEDICARE PTAN