Provider Demographics
NPI:1588224299
Name:OGUNBEKUN, EBONI DANIELLE PULLEN (DO)
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:DANIELLE PULLEN
Last Name:OGUNBEKUN
Suffix:
Gender:F
Credentials:DO
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-765-5470
Mailing Address - Fax:336-499-5428
Practice Address - Street 1:1730 KERNERSVILLE MEDICAL PKWY STE 104
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7198
Practice Address - Country:US
Practice Address - Phone:336-765-5470
Practice Address - Fax:336-499-5428
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2023-02124OtherNORTH CAROLINA MEDICAL BOARD