Provider Demographics
NPI:1396365151
Name:HEBERLE, EMILY ELIZABETH
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:HEBERLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 STATE ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9512
Mailing Address - Country:US
Mailing Address - Phone:585-905-6564
Mailing Address - Fax:
Practice Address - Street 1:3815 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-9512
Practice Address - Country:US
Practice Address - Phone:585-905-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680789163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical