Provider Demographics
NPI:1164658654
Name:EBERLIN, DIANA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:EBERLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 E GORE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-4033
Mailing Address - Country:US
Mailing Address - Phone:814-882-9337
Mailing Address - Fax:
Practice Address - Street 1:2229 E GORE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-4033
Practice Address - Country:US
Practice Address - Phone:814-882-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN281400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse