{
"Npi": {
"NPI": "1013492958",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ELEBO",
"FirstName": "IFEOMA",
"MiddleName": "NKEMDILIM JENNIFER",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "DNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "OBIDIGBO",
"OtherFirstName": "IFEOMA",
"OtherMiddleName": "NKEMDILIM JENNIFER",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "DNP, FNP, PMHNP",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3024 VANNA LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HENRICO",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23233-1783",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-528-9752",
"MailingAddressFaxNumber": "804-409-8005",
"FirstLinePracticeLocationAddress": "2301 HILLIARD RD STE 4",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HENRICO",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23228-4525",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-546-4966",
"PracticeLocationAddressFaxNumber": "804-250-4583",
"EnumerationDate": "09/26/2018",
"LastUpdateDate": "12/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "0024176472",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": "0024176472",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "0024176472",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}