Healthcare Provider Details

I. General information

NPI: 1093426652
Provider Name (Legal Business Name): JENNA ABBAS GEBARA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7637 W MORROW CIR
DEARBORN MI
48126-1154
US

IV. Provider business mailing address

7637 W MORROW CIR
DEARBORN MI
48126-1154
US

V. Phone/Fax

Practice location:
  • Phone: 313-641-1001
  • Fax:
Mailing address:
  • Phone: 313-641-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704363430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: