Provider Demographics
NPI:1871909747
Name:EBBEN, TREETIS
Entity type:Individual
Prefix:
First Name:TREETIS
Middle Name:
Last Name:EBBEN
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0517
Mailing Address - Country:US
Mailing Address - Phone:360-302-0955
Mailing Address - Fax:715-866-5244
Practice Address - Street 1:25533 STATE ROAD 35 # A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8533
Practice Address - Country:US
Practice Address - Phone:360-302-0955
Practice Address - Fax:715-866-5244
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information