Provider Demographics
NPI:1053993790
Name:ABRAHAM, CHANEL AMERICA (RN, MSN, PMHNP)
Entity type:Individual
Prefix:MS
First Name:CHANEL
Middle Name:AMERICA
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11222 ROSARITA DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3210
Mailing Address - Country:US
Mailing Address - Phone:714-709-3018
Mailing Address - Fax:
Practice Address - Street 1:11222 ROSARITA DR
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3210
Practice Address - Country:US
Practice Address - Phone:714-709-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95147927163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163W00000XNursing Service ProvidersRegistered Nurse