Provider Demographics
NPI:1639940869
Name:JARJU, EBRIMA
Entity Type:Individual
Prefix:MR
First Name:EBRIMA
Middle Name:
Last Name:JARJU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-2920
Mailing Address - Country:US
Mailing Address - Phone:608-598-7849
Mailing Address - Fax:608-467-6668
Practice Address - Street 1:726 MILKY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2920
Practice Address - Country:US
Practice Address - Phone:608-598-7849
Practice Address - Fax:608-467-6668
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver