Individual
JANIS D EBOLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
140 DOVER ST, SHELBYVILLE, TN 37160-2776
(931) 684-3426
(931) 684-5860
Mailing address
140 DOVER ST, SHELBYVILLE, TN 37160-2776
(931) 684-3426
(931) 684-5860
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN0000005513
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3897887
—
TN
01
—
4057644
BCBS
—
Enumeration date
07/11/2005
Last updated
07/14/2012
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