Provider Demographics
NPI:1306820642
Name:GEBHART, EILEEN M (CRNA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:GEBHART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 W THUNDERBIRD RD
Mailing Address - Street 2:C300
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-938-2848
Mailing Address - Fax:602-938-4401
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:C300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-938-2848
Practice Address - Fax:602-938-4401
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ040108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46055Medicare UPIN