Provider Demographics
NPI:1700638434
Name:EBWEKANE, LUCKSLEY NZALLE
Entity Type:Individual
Prefix:
First Name:LUCKSLEY
Middle Name:NZALLE
Last Name:EBWEKANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S GLEBE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2752
Mailing Address - Country:US
Mailing Address - Phone:620-418-3805
Mailing Address - Fax:
Practice Address - Street 1:2900 S GLEBE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2752
Practice Address - Country:US
Practice Address - Phone:620-418-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator