Provider Demographics
NPI:1669454849
Name:ABUELOUF, ABDULLAH I (CRNA)
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:I
Last Name:ABUELOUF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:ABE
Other - Middle Name:I
Other - Last Name:ABUELOUF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:4717 OAK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9742
Mailing Address - Country:US
Mailing Address - Phone:901-682-7665
Mailing Address - Fax:901-767-8486
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2123
Practice Address - Country:US
Practice Address - Phone:901-682-7665
Practice Address - Fax:901-767-8486
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN09025367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3600674Medicare ID - Type UnspecifiedCRNA