Basic Information
| Provider Information | |||||||||
| NPI: | 1982901781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAABE | ||||||||
| FirstName: | ADRIAN | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | RN, ANP-BC, GNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 CITY POINT DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172848222 | ||||||||
| FaxNumber: | 8175955718 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 CITY POINT DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172848222 | ||||||||
| FaxNumber: | 8175955718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2011 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 687012 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | 687012 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | P00943148 | 01 | TX | MEDICARE RAILROAD | OTHER | 352391YL7A | 01 | TX | MEDICARE - OTHER COUNTY | OTHER |