Provider Demographics
NPI:1831724897
Name:AMROU, KHOLOUD K (CNP)
Entity type:Individual
Prefix:
First Name:KHOLOUD
Middle Name:K
Last Name:AMROU
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3203 PEPPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9697
Mailing Address - Country:US
Mailing Address - Phone:419-704-1923
Mailing Address - Fax:
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-9905
Practice Address - Country:US
Practice Address - Phone:419-783-3251
Practice Address - Fax:419-783-2799
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP025874363L00000X
OHAPRN.CNP.0258742086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty