Provider Demographics
NPI:1306007364
Name:MARY EBERHART, WHNP-BC, P.L.L.C.
Entity Type:Organization
Organization Name:MARY EBERHART, WHNP-BC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP-BC
Authorized Official - Phone:940-382-5800
Mailing Address - Street 1:2921 COUNTRY CLUB RD
Mailing Address - Street 2:STE 103
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8624
Mailing Address - Country:US
Mailing Address - Phone:940-382-5800
Mailing Address - Fax:940-382-3299
Practice Address - Street 1:2921 COUNTRY CLUB RD
Practice Address - Street 2:STE 103
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8624
Practice Address - Country:US
Practice Address - Phone:940-382-5800
Practice Address - Fax:940-382-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518137363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062RKOtherBLUE CROSS BLUE SHIELD
TXS92666Medicare UPIN
TX0062RKOtherBLUE CROSS BLUE SHIELD