Individual
MS. JOAN ELLEN EBBLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC, RN
Contact information
Practice address
29690 STATE RT. 180, WATERTOWN, NY 13601
(315) 658-2110
Mailing address
29690 STATE RT. 180, WATERTOWN, NY 13601
(315) 658-2110
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
274794-1
NY
171100000X
Acupuncturist
Primary
003092-1
NY
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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