Basic Information
| Provider Information | |||||||||
| NPI: | 1407484181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NDEMATEBEM | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSN, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 735 DUGAN RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | BLACKLICK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430047124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145718223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2845 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2020 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.312991 | OH | N | Nursing Service Providers | Registered Nurse | 363LP0808X | APRN.CNP.0027902 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.