Provider Demographics
NPI:1780721993
Name:EBY, EMIE LOU (NP, RN)
Entity type:Individual
Prefix:MRS
First Name:EMIE
Middle Name:LOU
Last Name:EBY
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:MISS
Other - First Name:EMIE
Other - Middle Name:LOU
Other - Last Name:CABANSAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:835 GRANT ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1328
Mailing Address - Country:US
Mailing Address - Phone:310-450-8217
Mailing Address - Fax:310-450-8217
Practice Address - Street 1:9735 WILSHIRE BLVD
Practice Address - Street 2:SUITE 407
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2107
Practice Address - Country:US
Practice Address - Phone:310-887-6100
Practice Address - Fax:310-859-8970
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP # 15555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily