Provider Demographics
NPI:1164466140
Name:EBREO, ELLIE A (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELLIE
Middle Name:A
Last Name:EBREO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MC ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-867-5892
Mailing Address - Fax:956-686-3669
Practice Address - Street 1:420 W SAM HOUSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5308
Practice Address - Country:US
Practice Address - Phone:956-782-4002
Practice Address - Fax:956-687-6420
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688312163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory