Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A132130 | CA |
N | 207VX0000X | Obstetrician | A132130 | CA |
NPI | 1356784532 |
---|---|
Provider Name | Valerie Jane Ebel |
First Address | Arcata, CA 95521-6248 |
Second Address | Mckinleyville, CA 95519-4342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2013 |
Last Update Date | 21/12/2016 |