Provider Demographics
NPI:1942905583
Name:EBEN, AUDELIA (DO)
Entity type:Individual
Prefix:
First Name:AUDELIA
Middle Name:
Last Name:EBEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AUDELIA
Other - Middle Name:
Other - Last Name:EBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1316 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-5362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1316 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-5362
Practice Address - Country:US
Practice Address - Phone:660-627-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program