Provider Demographics
NPI:1558197855
Name:EHRENSBERGER, ISABELLA LUCY (PA-C)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:LUCY
Last Name:EHRENSBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEACH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-877-5700
Mailing Address - Fax:814-877-5655
Practice Address - Street 1:100 PEACH ST STE 102
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-877-5700
Practice Address - Fax:814-877-5655
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065930363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant