Provider Demographics
NPI:1275901704
Name:ELBESHIR, EBITEHAL (AGNP-C)
Entity Type:Individual
Prefix:
First Name:EBITEHAL
Middle Name:
Last Name:ELBESHIR
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2234
Mailing Address - Country:US
Mailing Address - Phone:313-804-0202
Mailing Address - Fax:
Practice Address - Street 1:4499 PARKER ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2234
Practice Address - Country:US
Practice Address - Phone:313-456-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG02230023363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner