Provider Demographics
NPI:1831680305
Name:EBONG, ALEXANDRA KATHERINE (DNP, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:KATHERINE
Last Name:EBONG
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:KATHERINE
Other - Last Name:SCHANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 S. COUNTRY CLUB DRIVE
Mailing Address - Street 2:STE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-413-0065
Mailing Address - Fax:480-413-0069
Practice Address - Street 1:1950 S. COUNTRY CLUB DRIVE
Practice Address - Street 2:STE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-413-0065
Practice Address - Fax:480-413-0069
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily