Healthcare Provider Details

I. General information

NPI: 1932838695
Provider Name (Legal Business Name): MICHELLE RENEE EBNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BABCOCK RD STE 111
SAN ANTONIO TX
78229-4899
US

IV. Provider business mailing address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-3108
  • Fax:
Mailing address:
  • Phone: 210-358-0572
  • Fax: 210-358-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1082973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: