Individual
MRS. JESSICA LYNN EBNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1902 E GORE BLVD, LAWTON, OK 73501-6102
(860) 480-6231
Mailing address
249 HAPPY HOLLOW LN, ELGIN, OK 73538-2142
(860) 480-6231
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
116547
OK
Other
Enumeration date
02/25/2020
Last updated
02/25/2020
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