Provider Demographics
NPI:1588400923
Name:AYOUB, MOUSSA WISSAM (FNP)
Entity type:Individual
Prefix:MR
First Name:MOUSSA
Middle Name:WISSAM
Last Name:AYOUB
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1652
Mailing Address - Country:US
Mailing Address - Phone:313-434-7676
Mailing Address - Fax:
Practice Address - Street 1:660 S WAVERLY ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1652
Practice Address - Country:US
Practice Address - Phone:313-434-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704363970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily