MEDICARE: MRS. VERA JABER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704267744	MI

General Provider Information

NPI Number	:	1871917724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERA JABER

Provider Business Mailing Address
First Line	:	PO BOX 7060
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48121-7060
Country	:	US
Telephone Number	:	313-413-8684
Fax Number	:	888-242-0942

Provider Business Practice Location Address
First Line	:	10140 VERNOR HWY
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48120-1515
Country	:	US
Telephone Number	:	313-413-8684
Fax Number	:	888-242-0942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	05/10/2017

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