Provider Demographics
NPI:1407484181
Name:NDEMATEBEM, JOSHUA (MSN, CNP)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:NDEMATEBEM
Suffix:
Gender:M
Credentials:MSN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 DUGAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7124
Mailing Address - Country:US
Mailing Address - Phone:614-571-8223
Mailing Address - Fax:
Practice Address - Street 1:2845 BELL ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1720
Practice Address - Country:US
Practice Address - Phone:740-454-9766
Practice Address - Fax:740-588-6452
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.312991163W00000X
OHAPRN.CNP.0027902363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse