Provider Demographics
NPI:1447623392
Name:EBOSELE, ANDREW (CNP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:EBOSELE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MILESTONE DR
Mailing Address - Street 2:APT 311
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:631 BRIGHT RD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6940
Practice Address - Country:US
Practice Address - Phone:419-424-0815
Practice Address - Fax:419-424-1405
Is Sole Proprietor?:No
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCTP.18114-EX1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily