Provider Demographics
NPI:1104082288
Name:ABRAHAM, JULIA AGNES (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:AGNES
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:AGNES
Other - Last Name:VERMEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1217
Mailing Address - Country:US
Mailing Address - Phone:605-428-5446
Mailing Address - Fax:605-428-2333
Practice Address - Street 1:111 E 10TH ST
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1217
Practice Address - Country:US
Practice Address - Phone:605-428-5446
Practice Address - Fax:605-428-2333
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6829854Medicaid
SD6829853Medicaid
SD6829850Medicaid
SD6829852Medicaid
SD6829850Medicaid