Basic Information
| Provider Information | |||||||||
| NPI: | 1477223311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELEBO | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | IKECHUKWU | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4810 KEMPAIR CT | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221934631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712417876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220423307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037763814 | ||||||||
| FaxNumber: | 7037764028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2021 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024182214 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 2084P0800X | 0024182214 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.