Individual
CONNIE M EBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R22087
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19686
—
ND
Enumeration date
09/15/2006
Last updated
04/23/2025
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