Healthcare Provider Details

I. General information

NPI: 1356265417
Provider Name (Legal Business Name): RACHAEL EBEGBONI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S DAVIS AVE
COLUMBUS OH
43222-1504
US

IV. Provider business mailing address

127 S DAVIS AVE
COLUMBUS OH
43222-1504
US

V. Phone/Fax

Practice location:
  • Phone: 213-458-7841
  • Fax:
Mailing address:
  • Phone: 213-458-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10065037
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: