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General NPI Number Information
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NPI Number | 1750943155
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Entity Type | Individual
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Provider Name | STACIE LYNNE EBERSOLD MSN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 100 S JUNIPER ST FL 3
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1316
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Country | US
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Telephone | 866-849-0692
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211699
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City | EAGAN
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State | MN
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Zip | 55121-3699
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Country | US
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Telephone |
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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 | APRN11041685
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP020581
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License Number State | PA
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