Individual
MRS. LORI NICOLE EBENKAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CPNP-PC
Contact information
Practice address
1915 MAYFIELD ROAD #115, ARLINGTON, TX 76014-2605
(682) 276-6700
Mailing address
1915 E MAYFIELD RD STE 115, ARLINGTON, TX 76014-2605
(682) 276-6700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
747314
TX
363LP0200X
Pediatric Nurse Practitioner
Primary
AP139365
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28150
RX AUTHORIZATION
TX
01
—
747314
RN
TX
01
—
AP139365
APRN
TX
Enumeration date
12/03/2018
Last updated
10/28/2021
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