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General NPI Number Information
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NPI Number | 1639834492
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Entity Type | Individual
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Provider Name | SAMANTHA EBERT NP STUDENT
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Gender | Female
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Dates
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Enumeration Date | 11/05/2021
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 612 KINGSBOROUGH SQ STE 100
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5041
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Country | US
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Telephone | 757-547-9294
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Fax | 757-213-9345
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Provider Business Mailing Address
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Address Line | 901 BOWLING GREEN TRL
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3111
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Country | US
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Telephone | 949-690-0638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | STUDENT
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License Number State | VA
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