Provider Demographics
NPI:1770521395
Name:EBERLY, LAVERTA Y (ARNP)
Entity type:Individual
Prefix:
First Name:LAVERTA
Middle Name:Y
Last Name:EBERLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3855
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:503 3RD ST
Practice Address - Street 2:
Practice Address - City:KALONA
Practice Address - State:IA
Practice Address - Zip Code:52247-9526
Practice Address - Country:US
Practice Address - Phone:319-656-3151
Practice Address - Fax:319-656-3319
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA040752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0423335Medicaid
IACG7398OtherRAILROAD MEDICARE
IA0423335Medicaid
IACG7398OtherRAILROAD MEDICARE