Provider Demographics
NPI:1659812592
Name:ABU, ALFRED (CRNP)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:ABU
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-5408
Mailing Address - Fax:610-567-6955
Practice Address - Street 1:832 ARBOR RD
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3602
Practice Address - Country:US
Practice Address - Phone:610-304-2550
Practice Address - Fax:610-259-2932
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-11
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily