Healthcare Provider Details

I. General information

NPI: 1023835865
Provider Name (Legal Business Name): KIMBERLY EBEL RN, PCD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WOODSIDE TER
WEST ORANGE NJ
07052-5024
US

IV. Provider business mailing address

43 WOODSIDE TER
WEST ORANGE NJ
07052-5024
US

V. Phone/Fax

Practice location:
  • Phone: 201-956-0704
  • Fax:
Mailing address:
  • Phone: 201-956-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number26NR16771200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: