Healthcare Provider Details

I. General information

NPI: 1740268168
Provider Name (Legal Business Name): ANGELA ELIZABETH EBERHART C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CHILDREN'S PLAZA
DAYTON OH
45404-4540
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3000
  • Fax:
Mailing address:
  • Phone: 937-641-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP06424
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number06424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: