Provider Demographics
NPI:1093426652
Name:GEBARA, JENNA ABBAS (FNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ABBAS
Last Name:GEBARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7637 W MORROW CIR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1154
Mailing Address - Country:US
Mailing Address - Phone:313-641-1001
Mailing Address - Fax:
Practice Address - Street 1:7637 W MORROW CIR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1154
Practice Address - Country:US
Practice Address - Phone:313-641-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704363430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily