Healthcare Provider Details

I. General information

NPI: 1508233834
Provider Name (Legal Business Name): MRS. KRISTEN LEE EBBESKOTTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

# L-3688
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax: 419-228-3352
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.350534
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: