Individual
EBUN OSAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
311 W. FAIRCHILD STREET, FAMILY MEDICINE/CONVENIENT CARE, DANVILLE, IL 61832
(217) 431-7650
(217) 431-7634
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2529
(217) 383-6792
(217) 383-4752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
85001739
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0533210001
DMERC
IL
01
—
P00156941
RAILROAD
IL
Enumeration date
01/16/2007
Last updated
05/08/2014
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