Provider Demographics
NPI:1023423134
Name:ILOGU, EBELE (MSN,APN-C)
Entity type:Individual
Prefix:
First Name:EBELE
Middle Name:
Last Name:ILOGU
Suffix:
Gender:F
Credentials:MSN,APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHOCTAW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-5437
Mailing Address - Country:US
Mailing Address - Phone:732-762-6214
Mailing Address - Fax:
Practice Address - Street 1:18 CHOCTAW RIDGE RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-5437
Practice Address - Country:US
Practice Address - Phone:732-762-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00506300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner