Provider Demographics
NPI:1821152844
Name:ABRAHAM, MINIJA A (WHCNP)
Entity Type:Individual
Prefix:
First Name:MINIJA
Middle Name:A
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E PLANO PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6860
Mailing Address - Country:US
Mailing Address - Phone:972-423-2275
Mailing Address - Fax:972-423-2277
Practice Address - Street 1:811 E PLANO PKWY STE 108
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6860
Practice Address - Country:US
Practice Address - Phone:972-423-2275
Practice Address - Fax:972-423-2277
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110719363LW0102X
TX623282363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144914201Medicaid
TX1821152844OtherINDIVIDUAL NPI
TX1225729973OtherNPI