Healthcare Provider Details

I. General information

NPI: 1447202767
Provider Name (Legal Business Name): DEBORAH SUE EBERLE RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PARKVIEW DR SUITE 1
KITTANNING PA
16201-7105
US

IV. Provider business mailing address

104 PARKVIEW DR SUITE 1
KITTANNING PA
16201-7105
US

V. Phone/Fax

Practice location:
  • Phone: 844-328-9473
  • Fax: 724-545-7233
Mailing address:
  • Phone: 844-328-9473
  • Fax: 724-545-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN002339
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN002339
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: