Provider Demographics
NPI:1477223311
Name:ELEBO, ALEXANDER IKECHUKWU (DNP, NP)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:IKECHUKWU
Last Name:ELEBO
Suffix:
Gender:M
Credentials:DNP, NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 KEMPAIR CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4631
Mailing Address - Country:US
Mailing Address - Phone:571-241-7876
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-3814
Practice Address - Fax:703-776-4028
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182214363L00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry