Healthcare Provider Details

I. General information

NPI: 1164466140
Provider Name (Legal Business Name): ELLIE A EBREO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W SAM HOUSTON ST SUITE A
PHARR TX
78577-5308
US

IV. Provider business mailing address

2500 FULLERTON AVE
MC ALLEN TX
78504
US

V. Phone/Fax

Practice location:
  • Phone: 956-782-4002
  • Fax: 956-687-6420
Mailing address:
  • Phone: 956-867-5892
  • Fax: 956-686-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number688312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: