Individual
BRYAN J EBELING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1298 W FINNIE FLAT RD, CAMP VERDE, AZ 86322-5958
(928) 639-5555
Mailing address
7805 W SWEETWATER TRL, FLAGSTAFF, AZ 86001-8191
(435) 749-0078
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
239674
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F03200300
AANP
—
Enumeration date
03/23/2020
Last updated
01/14/2021
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