Provider Demographics
NPI:1407337744
Name:EBERHART, CHARLES HENRY III (LVN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HENRY
Last Name:EBERHART
Suffix:III
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7018
Mailing Address - Country:US
Mailing Address - Phone:254-791-4545
Mailing Address - Fax:
Practice Address - Street 1:990 MARLANDWOOD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3365
Practice Address - Country:US
Practice Address - Phone:254-791-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162842164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse