Provider Demographics
NPI:1497429781
Name:ALASAL, EBTHAL (NP)
Entity Type:Individual
Prefix:
First Name:EBTHAL
Middle Name:
Last Name:ALASAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2568
Mailing Address - Country:US
Mailing Address - Phone:260-347-8700
Mailing Address - Fax:
Practice Address - Street 1:2007 CORTLAND LN
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2875
Practice Address - Country:US
Practice Address - Phone:260-242-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28233679A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily