Provider Demographics
NPI:1689548505
Name:JAROUSH, NASSEEB AMEEN
Entity type:Individual
Prefix:
First Name:NASSEEB
Middle Name:AMEEN
Last Name:JAROUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-0322
Mailing Address - Country:US
Mailing Address - Phone:919-645-7949
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 322
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-0322
Practice Address - Country:US
Practice Address - Phone:919-645-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20717637172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver