Individual
CHERISH DIVINA EBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C0002427
MD
363AM0700X
Medical Physician Assistant
MA003067L
PA
363AS0400X
Surgical Physician Assistant
Primary
MA003067L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103150701
—
PA
01
—
25-1716306
INTERGROUP
PA
01
—
50089803
CAPITAL BLUECROSS
PA
01
—
867633
MEDICARE GROUP #
PA
01
—
MA003067L
LICENSE
PA
Enumeration date
06/06/2006
Last updated
03/07/2023
Update your record
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