Provider Demographics
NPI:1568271500
Name:EBERL, STEPHANIE (RN, CCM)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:EBERL
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 KEEVER AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-3553
Mailing Address - Country:US
Mailing Address - Phone:716-803-5693
Mailing Address - Fax:
Practice Address - Street 1:137 KEEVER AVE
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-3553
Practice Address - Country:US
Practice Address - Phone:716-803-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY642610-01163WC0400X
NY6426410-01163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management