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General NPI Number Information
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NPI Number | 1093050841
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Entity Type | Individual
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Provider Name | EBELE N ILOABACHIE
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Gender | Female
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 141 MARKET PL STE 100
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2089
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Country | US
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Telephone | 618-398-4226
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Fax | 618-398-1759
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Provider Business Mailing Address
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Address Line | 7006 STONY RIDGE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63129-6405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.010250
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2021048982
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2012036151
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277003973
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License Number State | IL
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