Provider Demographics
NPI:1205139110
Name:ABRAHAM, DEBRA R (ANP-BC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:R
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 COLFAX RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1113
Mailing Address - Country:US
Mailing Address - Phone:610-446-2817
Mailing Address - Fax:
Practice Address - Street 1:143 COLFAX RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-1113
Practice Address - Country:US
Practice Address - Phone:610-446-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP10839363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health