Healthcare Provider Details

I. General information

NPI: 1669863148
Provider Name (Legal Business Name): EBONEE EMANUEL WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MESSIMER DR
NEWARK OH
43055-1841
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4677
  • Fax: 220-564-4678
Mailing address:
  • Phone: 614-722-6200
  • Fax: 614-355-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number389194RN
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number16957NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: