Provider Demographics
NPI:1902972862
Name:EBELKE, CATHERINE INA (PA)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:INA
Last Name:EBELKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:SWINGLE STUDENT HEALTH CENTER MONTANA STATE UNIVERSITY
Mailing Address - Street 2:PO BOX 173260
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59717-3260
Mailing Address - Country:US
Mailing Address - Phone:406-994-2311
Mailing Address - Fax:406-994-2504
Practice Address - Street 1:SWINGLE STUDENT HEALTH CENTER MONTANA STATE UNIVERSITY
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59717-3260
Practice Address - Country:US
Practice Address - Phone:406-994-2311
Practice Address - Fax:406-994-2504
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant