Provider Demographics
NPI:1801041637
Name:EBERT, JOYCE GAIL (IV CERTIFIED LPN)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:GAIL
Last Name:EBERT
Suffix:
Gender:F
Credentials:IV CERTIFIED LPN
Other - Prefix:MS
Other - First Name:JOYCE
Other - Middle Name:GAIL
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7529 WEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-1209
Mailing Address - Country:US
Mailing Address - Phone:314-503-2185
Mailing Address - Fax:
Practice Address - Street 1:7529 WEAVER AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-1209
Practice Address - Country:US
Practice Address - Phone:314-503-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO024708164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse