MEDICARE: BERDINE K EBY ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	44299	KS

General Provider Information

NPI Number	:	1023002490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERDINE K EBY ARNP-C

Provider Business Mailing Address
First Line	:	1133 COLLEGE AVE
Second Line	:	BLDG. E-210
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2770
Country	:	US
Telephone Number	:	785-537-1414
Fax Number	:	785-537-0623

Provider Business Practice Location Address
First Line	:	1133 COLLEGE AVE
Second Line	:	BLDG. E-210
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2770
Country	:	US
Telephone Number	:	785-537-1414
Fax Number	:	785-537-0623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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