Provider Demographics
NPI:1952730020
Name:NUNN, ABRAM WOLFE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ABRAM
Middle Name:WOLFE
Last Name:NUNN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BRADSHAW RD STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3277
Mailing Address - Country:US
Mailing Address - Phone:916-368-1500
Mailing Address - Fax:
Practice Address - Street 1:3635 BRADSHAW RD STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3277
Practice Address - Country:US
Practice Address - Phone:916-368-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant