Healthcare Provider Details

I. General information

NPI: 1285386094
Provider Name (Legal Business Name): AYIA ABDELJABBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 S HOWELL AVE STE 217
OAK CREEK WI
53154-2122
US

IV. Provider business mailing address

7435 S HOWELL AVE STE 217
OAK CREEK WI
53154-2122
US

V. Phone/Fax

Practice location:
  • Phone: 414-916-6100
  • Fax:
Mailing address:
  • Phone: 414-916-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020010061
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17180-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: