=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598132383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARI EBERHARDT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2015
-----------------------------------------------------
Last Update Date | 04/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | JOURNEY MENTAL HEALTH CENTER 25 KESSEL CT
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-280-3145
-----------------------------------------------------
Fax | 608-280-2428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | JOURNEY MENTAL HEALTH CENTER 25 KESSEL CT
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-280-3145
-----------------------------------------------------
Fax | 608-280-2428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 189691
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------