Provider Demographics
NPI:1063897288
Name:ABRAHAM, KIONIE
Entity type:Individual
Prefix:
First Name:KIONIE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FAIRFIELD WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1559
Mailing Address - Country:US
Mailing Address - Phone:630-529-7427
Mailing Address - Fax:630-529-9937
Practice Address - Street 1:2 TRANSAM PLAZA DR STE 410
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4290
Practice Address - Country:US
Practice Address - Phone:866-259-1631
Practice Address - Fax:855-618-2629
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012812363LF0000X
IL209-012812363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health