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General NPI Number Information
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NPI Number | 1578297313
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Entity Type | Individual
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Provider Name | EBONY CHATMON
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Gender | Female
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1001 EASTON RD STE 104
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City | WILLOW GROVE
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State | PA
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Zip | 19090-2037
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Country | US
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Telephone | 267-403-1475
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Fax | 877-866-2051
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Provider Business Mailing Address
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Address Line | PO BOX
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City | GLENSIDE
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State | PA
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Zip | 19038-2514
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Country | US
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Telephone | 215-315-8665
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN11017838
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License Number State | FL
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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 | PMH04250056
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP023351
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License Number State | PA
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