Provider Demographics
NPI:1750943155
Name:EBERSOLD, STACIE LYNNE (MSN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LYNNE
Last Name:EBERSOLD
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MONUMENT RD
Mailing Address - Street 2:STE 220
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5049
Mailing Address - Country:US
Mailing Address - Phone:717-577-9592
Mailing Address - Fax:
Practice Address - Street 1:680 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2223
Practice Address - Country:US
Practice Address - Phone:717-577-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily