Provider Demographics
NPI:1730863010
Name:EBSEN, AUDRA MAE (BSW)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:MAE
Last Name:EBSEN
Suffix:
Gender:F
Credentials:BSW
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 492
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-0492
Mailing Address - Country:US
Mailing Address - Phone:720-837-1004
Mailing Address - Fax:
Practice Address - Street 1:20971 E SMOKY HILL RD STE 204
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5187
Practice Address - Country:US
Practice Address - Phone:720-837-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program