Provider Demographics
NPI:1295995660
Name:ABRAHAM, KELLY S (LPN 305735031)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LPN 305735031
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PUMPHOUSE RD
Mailing Address - Street 2:APT #26
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729
Mailing Address - Country:US
Mailing Address - Phone:715-726-3084
Mailing Address - Fax:
Practice Address - Street 1:400 PUMPHOUSE RD
Practice Address - Street 2:APT #26
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-726-3084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305735031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse