Provider Demographics
NPI:1851863880
Name:EBEL, JEANET (LPN)
Entity Type:Individual
Prefix:
First Name:JEANET
Middle Name:
Last Name:EBEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 KESTREL LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7748
Mailing Address - Country:US
Mailing Address - Phone:262-309-2328
Mailing Address - Fax:262-574-0994
Practice Address - Street 1:2314 KESTREL LN
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7748
Practice Address - Country:US
Practice Address - Phone:262-309-2328
Practice Address - Fax:262-574-0994
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI323232164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty