Provider Demographics
NPI:1982901781
Name:RAABE, ADRIAN JANE (AGPCNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:JANE
Last Name:RAABE
Suffix:
Gender:F
Credentials:AGPCNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:469-797-2101
Mailing Address - Fax:817-730-0510
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:469-797-2101
Practice Address - Fax:817-730-0510
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119771363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00943148OtherMEDICARE RAILROAD
TX352391YL7AOtherMEDICARE - OTHER COUNTY
TX352391YL7AOtherMEDICARE - OTHER COUNTY