Individual
JENNIFER E EBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 257-1274
(937) 656-1235
Mailing address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 257-1274
(937) 656-1235
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078477
—
OH
01
—
50003574
OHIO LICENSE
OH
Enumeration date
08/14/2012
Last updated
11/09/2023
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