Individual
MISS EDEN EMBREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 E. 17TH STREET, ASSEMBLY HALL, BLOOMINGTON, IN 47408
(812) 855-4509
Mailing address
3412 HICKORY HILL TRL, FORT WAYNE, IN 46804-6087
(260) 452-5559
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/11/2014
Last updated
05/20/2015
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