Healthcare Provider Details

I. General information

NPI: 1003646795
Provider Name (Legal Business Name): EBITARI O FREGENE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8517 AIRLINE AVE
URBANDALE IA
50322-2317
US

IV. Provider business mailing address

115 GOLDEN GATE PKWY
WENTZVILLE MO
63385-7288
US

V. Phone/Fax

Practice location:
  • Phone: 636-634-5668
  • Fax:
Mailing address:
  • Phone: 636-634-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024031047
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: