Healthcare Provider Details

I. General information

NPI: 1548115074
Provider Name (Legal Business Name): NOUR JABALY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7637 SHADYWOOD LN
SYLVANIA OH
43560-1869
US

IV. Provider business mailing address

7637 SHADYWOOD LN
SYLVANIA OH
43560-1869
US

V. Phone/Fax

Practice location:
  • Phone: 419-973-0250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0043425
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: