Individual
ADELINE ETOGHE ABAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 335-3022
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
(817) 569-4039
(817) 810-3042
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
786779
TX
363LF0000X
Family Nurse Practitioner
786779
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP129503
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8450NS
BCBS
TX
Enumeration date
10/15/2015
Last updated
05/25/2021
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