Healthcare Provider Details

I. General information

NPI: 1871909747
Provider Name (Legal Business Name): TREETIS EBBEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25533 STATE ROAD 35 # A
WEBSTER WI
54893-8533
US

IV. Provider business mailing address

PO BOX 517
SIREN WI
54872-0517
US

V. Phone/Fax

Practice location:
  • Phone: 360-302-0955
  • Fax: 715-866-5244
Mailing address:
  • Phone: 360-302-0955
  • Fax: 715-866-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: