Provider Demographics
NPI:1639679699
Name:EBERLE, DANE SAGE
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:SAGE
Last Name:EBERLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 JASON DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6018
Mailing Address - Country:US
Mailing Address - Phone:814-806-7786
Mailing Address - Fax:
Practice Address - Street 1:5228 JASON DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-6018
Practice Address - Country:US
Practice Address - Phone:814-806-7786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program