Provider Demographics
NPI:1932484128
Name:EBNET, NICOLE A (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:EBNET
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-2943
Mailing Address - Country:US
Mailing Address - Phone:320-632-2380
Mailing Address - Fax:
Practice Address - Street 1:1101 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-2943
Practice Address - Country:US
Practice Address - Phone:320-632-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist