Provider Demographics
NPI:1629381959
Name:EBIE, VERONICA N
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:N
Last Name:EBIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:N
Other - Last Name:EBIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MSWOCN
Mailing Address - Street 1:6420 HILLCROFT ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3190
Mailing Address - Country:US
Mailing Address - Phone:713-270-4800
Mailing Address - Fax:
Practice Address - Street 1:6420 HILLCROFT ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3190
Practice Address - Country:US
Practice Address - Phone:713-270-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX438444171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311588332Medicaid