Healthcare Provider Details

I. General information

NPI: 1093560294
Provider Name (Legal Business Name): NOURA MOHAMED IBRAHIM ELEBIARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 SUTTON WAY
GRASS VALLEY CA
95945-5182
US

IV. Provider business mailing address

14845 DURDEN CT
GRASS VALLEY CA
95949-9266
US

V. Phone/Fax

Practice location:
  • Phone: 530-272-8881
  • Fax:
Mailing address:
  • Phone: 530-887-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH89377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: