Provider Demographics
NPI:1114615168
Name:EBNOTHER, JAMIE JILL (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:JILL
Last Name:EBNOTHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 SUNRIDGE HEIGHTS PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4462
Mailing Address - Country:US
Mailing Address - Phone:725-291-5900
Mailing Address - Fax:
Practice Address - Street 1:2960 SUNRIDGE HEIGHTS PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4462
Practice Address - Country:US
Practice Address - Phone:725-291-5900
Practice Address - Fax:725-291-5901
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV866283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty