Provider Demographics
NPI:1316549884
Name:EBRON, MICHELLE PATRICE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PATRICE
Last Name:EBRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-2117
Mailing Address - Country:US
Mailing Address - Phone:757-751-2528
Mailing Address - Fax:
Practice Address - Street 1:5501 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2117
Practice Address - Country:US
Practice Address - Phone:757-751-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVVN-6086343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)