Provider Demographics
NPI:1336543230
Name:JABBOUR, LAURA (CNM)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:JABBOUR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CHEEVER PL
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3034
Mailing Address - Country:US
Mailing Address - Phone:516-661-0819
Mailing Address - Fax:
Practice Address - Street 1:59 CHEEVER PL
Practice Address - Street 2:APT 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3034
Practice Address - Country:US
Practice Address - Phone:516-661-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001649367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife