| NPI | 1336238013 |
|---|---|
| Former Name | NICOLE LEANN EBY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052212) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052212) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA OA004470) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2025-04-22 |