Individual
NONNA LYN M EBALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2212 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 572-8921
(434) 572-2063
Mailing address
2212 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 572-8921
(434) 572-2063
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101232220
VA
208000000X
Pediatrics Physician
C51721
CA
Other
Enumeration date
01/19/2006
Last updated
09/24/2012
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