Provider Demographics
NPI:1811689144
Name:ABRAHAM, DOUGLAS JOHAN (APRN, FNP-C, ENP-C,)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JOHAN
Last Name:ABRAHAM
Suffix:
Gender:
Credentials:APRN, FNP-C, ENP-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49016-0670
Mailing Address - Country:US
Mailing Address - Phone:269-282-9022
Mailing Address - Fax:844-332-3887
Practice Address - Street 1:2 MICHIGAN AVE W STE 201
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3621
Practice Address - Country:US
Practice Address - Phone:269-282-9022
Practice Address - Fax:844-332-3887
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704341949363L00000X
MIE3282482146N00000X
WY52167163WE0003X, 363LF0000X, 363LC0200X
HI90980163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8741312240OtherNRCME-DOT