Provider Demographics
NPI:1932552700
Name:KHOURY, MEIRAY (NP)
Entity type:Individual
Prefix:
First Name:MEIRAY
Middle Name:
Last Name:KHOURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WOODWARD AVE STE 2430
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3502
Mailing Address - Country:US
Mailing Address - Phone:313-457-9355
Mailing Address - Fax:313-447-2444
Practice Address - Street 1:660 WOODWARD AVE STE 2430
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3502
Practice Address - Country:US
Practice Address - Phone:313-457-9355
Practice Address - Fax:313-447-2444
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281654363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health