Individual provider · NPI-1

Brice Boby Abraham

Anesthesiologist Assistant · Fort Wayne, IN

NPI number1386492197
StatusActive
Last updated in NPPESNov 4, 2024

Details

NPI
1386492197
Entity type
Individual (NPI-1)
Name
Brice Boby Abraham
Sex
Female
Sole proprietor
No
Enumeration date
May 7, 2024
Certification date
Nov 4, 2024
Last updated
Nov 4, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
367H00000X Anesthesiologist Assistant75000193AINYes
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

11141 Parkview Plaza Dr Ste 200
Fort Wayne, IN 46845-1714

Phone 260-425-6030 · Fax 260-425-6028

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

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