Provider Demographics
NPI:1487259164
Name:EKOBENI, ALICE MARCELLE (CRNP)
Entity type:Individual
Prefix:
First Name:ALICE MARCELLE
Middle Name:
Last Name:EKOBENI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 GORDON HOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9976
Mailing Address - Country:US
Mailing Address - Phone:215-288-5840
Mailing Address - Fax:
Practice Address - Street 1:695 GORDON HOUSE WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9976
Practice Address - Country:US
Practice Address - Phone:215-288-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021622363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care