Provider Demographics
NPI:1003594615
Name:EBEL, LANEA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LANEA
Middle Name:
Last Name:EBEL
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 CENTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-1792
Mailing Address - Country:US
Mailing Address - Phone:920-310-1616
Mailing Address - Fax:
Practice Address - Street 1:1614 CENTER ST STE 1
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1792
Practice Address - Country:US
Practice Address - Phone:920-310-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22165-40183500000X
IN26031214A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist