Most Relevant Information
Provider Data
| NPI Number: | 1003660721 |
| Provider Name: | AMANDA IRENE EBERT |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/17/2024 |
| Last Updated: | 04/17/2024 |
Provider Practice Location
101 WHITE EAGLE DR
PONCA CITY
OK
746018307
Practice Location Phone/Fax
| Phone: | 5807623421 |
| Fax: |
Provider Mailing Location
101 WHITE EAGLE DR
PONCA CITY
OK
746018307
Provider Mailing Phone/Fax
| Phone: | 5807623421 |
| Fax: |