Healthcare Provider Details

I. General information

NPI: 1487047379
Provider Name (Legal Business Name): MAYSOUN YOSSEF EL JAROUCHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W WOOSTER ST STE 107
BOWLING GREEN OH
43402-2646
US

IV. Provider business mailing address

5532 WADSWORTH DR
SYLVANIA OH
43560-3750
US

V. Phone/Fax

Practice location:
  • Phone: 419-373-7692
  • Fax: 419-373-4198
Mailing address:
  • Phone: 419-250-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: