Provider Demographics
NPI:1043650534
Name:CEBULLA, WILLIAM CLARE (RN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLARE
Last Name:CEBULLA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29538 OLINDA TRL
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9440
Mailing Address - Country:US
Mailing Address - Phone:651-247-9069
Mailing Address - Fax:
Practice Address - Street 1:29538 OLINDA TRL
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9440
Practice Address - Country:US
Practice Address - Phone:651-247-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 140921-5163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult