Provider Demographics
NPI:1972073872
Name:EBACHER, HAILEY ROSE
Entity Type:Individual
Prefix:MISS
First Name:HAILEY
Middle Name:ROSE
Last Name:EBACHER
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 1:1015 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2559
Mailing Address - Country:US
Mailing Address - Phone:320-290-5891
Mailing Address - Fax:
Practice Address - Street 1:1015 IRVING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2559
Practice Address - Country:US
Practice Address - Phone:320-290-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program