1588630792 NPI number — MRS. CORLENE ANN EBERLE ARNP FNPC ANPC

Table of content: MRS. CORLENE ANN EBERLE ARNP FNPC ANPC (NPI 1588630792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588630792 NPI number — MRS. CORLENE ANN EBERLE ARNP FNPC ANPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBERLE
Provider First Name:
CORLENE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP FNPC ANPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588630792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2414 LINDA LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-758-6298
Provider Business Mailing Address Fax Number:
509-758-6514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
733 5TH ST
Provider Second Line Business Practice Location Address:
STE M, LOW COST FAMILY HEALTH
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-758-6298
Provider Business Practice Location Address Fax Number:
509-758-6514
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30003864 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: NP241A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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