Provider Demographics
NPI:1669863148
Name:EMANUEL, EBONEE (WHNP)
Entity type:Individual
Prefix:
First Name:EBONEE
Middle Name:
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1841
Mailing Address - Country:US
Mailing Address - Phone:220-564-4677
Mailing Address - Fax:220-564-4678
Practice Address - Street 1:15 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1841
Practice Address - Country:US
Practice Address - Phone:220-564-4677
Practice Address - Fax:220-564-4678
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH389194RN163W00000X
OH16957NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0119012Medicaid
OH0119012Medicaid