Provider Demographics
NPI:1679633739
Name:ABRAHAM, JERRIE EDNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JERRIE
Middle Name:EDNA
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 E MOUNTAIN VIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-5829
Mailing Address - Country:US
Mailing Address - Phone:541-928-0914
Mailing Address - Fax:541-928-8846
Practice Address - Street 1:2571 E MOUNTAIN VIEW DR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5829
Practice Address - Country:US
Practice Address - Phone:541-928-0914
Practice Address - Fax:541-928-8846
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health