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General NPI Number Information
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NPI Number | 1528845781
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Entity Type | Individual
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Provider Name | EBONI NICOLE SOULE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 164 RAILROAD ST
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-6010
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Country | US
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Telephone | 757-342-6398
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Fax |
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Provider Business Mailing Address
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Address Line | 164 RAILROAD ST
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-6010
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Country | US
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Telephone | 757-342-6398
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024187980
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License Number State | VA
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