Provider Demographics
NPI:1568487783
Name:EBERSOLE, JOHN P (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:EBERSOLE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 DUBLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-7945
Mailing Address - Country:US
Mailing Address - Phone:989-839-8207
Mailing Address - Fax:
Practice Address - Street 1:6008 DUBLIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7945
Practice Address - Country:US
Practice Address - Phone:989-859-5584
Practice Address - Fax:989-839-8207
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704079277207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology