Healthcare Provider Details

I. General information

NPI: 1619648367
Provider Name (Legal Business Name): EJOBOSELE PEACE IKHAJIAGBE CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHAMBERS HILL DR STE 200
CHAMBERSBURG PA
17201-7301
US

IV. Provider business mailing address

111 CHAMBERS HILL DR STE 200
CHAMBERSBURG PA
17201-7304
US

V. Phone/Fax

Practice location:
  • Phone: 717-709-7930
  • Fax: 717-709-7931
Mailing address:
  • Phone: 717-709-7922
  • Fax: 717-263-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR219201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: