Provider Demographics
NPI:1750111308
Name:KHOURY, NAELLA (LPN)
Entity type:Individual
Prefix:
First Name:NAELLA
Middle Name:
Last Name:KHOURY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5438 BISHOPS BLVD S UNIT B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7210
Mailing Address - Country:US
Mailing Address - Phone:267-253-4955
Mailing Address - Fax:
Practice Address - Street 1:5438 BISHOPS BLVD S UNIT B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7210
Practice Address - Country:US
Practice Address - Phone:267-253-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL16595164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse