Individual
MISS DEEDEE IMAFORTOR EBALU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
480 EVERSMAN DR, JASPER, IN 47546-3548
(812) 482-3020
(812) 203-5848
Mailing address
480 EVERSMAN DR, JASPER, IN 47546-3548
(812) 482-3020
(812) 203-5848
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
026338
NY
363A00000X
Physician Assistant
Primary
10004709B
IN
Other
Enumeration date
02/14/2021
Last updated
05/09/2025
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