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NPI Code Detail

MEDICARE: JANIS D EBOLUM APRN-BC

MEDICARE: JANIS D EBOLUM APRN-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPN0000005513TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24057644OTHERBCBS

General Provider Information

NPI Number : 1710985072
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANIS D EBOLUM APRN-BC
Provider Business Mailing Address
First Line : 140 DOVER ST
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-2776
Country : US
Telephone Number : 931-684-3426
Fax Number : 931-684-5860
Provider Business Practice Location Address
First Line : 140 DOVER ST
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-2776
Country : US
Telephone Number : 931-684-3426
Fax Number : 931-684-5860
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 07/14/2012

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1972639698 — MRS. TONYA MAY VILLEGAS LPN
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1821128638 — MARTHA TALLEY RN
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140 DOVER ST
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37160-2776
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1851422968 — PROF. KELLY CLIFFORD
Practice Location Address:
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37160-2776
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Directions to “ JANIS D EBOLUM APRN-BC” Practice Location

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