Individual
RAVEN EBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
44 N 1ST E, PRESTON, ID 83263-1326
(208) 852-2900
(208) 852-3511
Mailing address
44 N 1ST E, PRESTON, ID 83263-1326
(208) 852-4100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
59770
ID
Other
Enumeration date
03/08/2024
Last updated
05/15/2024
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