Provider Demographics
NPI:1225699101
Name:EBERLIN, JOAN (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:EBERLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORNELL CT S
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3002
Mailing Address - Country:US
Mailing Address - Phone:631-499-0715
Mailing Address - Fax:
Practice Address - Street 1:1 CORNELL CT S
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3002
Practice Address - Country:US
Practice Address - Phone:631-499-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630785163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool