Provider Demographics
NPI:1982625299
Name:HABERL, EVELYN DARLENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:DARLENE
Last Name:HABERL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 GOTT CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1922
Mailing Address - Country:US
Mailing Address - Phone:716-862-8637
Mailing Address - Fax:716-862-8640
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:VA WESTERN NEW YORK HEALTHCARE SYSTEM
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302712-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health