Provider Demographics
NPI:1942793831
Name:ABRAHAM, MITTU CHERIAN
Entity Type:Individual
Prefix:
First Name:MITTU
Middle Name:CHERIAN
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E ASH LN APT 1025
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-4786
Mailing Address - Country:US
Mailing Address - Phone:469-709-0453
Mailing Address - Fax:
Practice Address - Street 1:800 E ASH LN APT 1025
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-4786
Practice Address - Country:US
Practice Address - Phone:469-709-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX832825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse