Provider Demographics
NPI:1730989450
Name:DABOUL, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DABOUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3858
Mailing Address - Country:US
Mailing Address - Phone:419-291-0159
Mailing Address - Fax:419-479-2617
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3858
Practice Address - Country:US
Practice Address - Phone:419-291-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program