Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 189163 | GA |
NPI | 1366993149 |
---|---|
Provider Name | Mrs. Stacy Eberhart |
First Address | Winston, GA 30187-2226 |
Second Address | Dalton, GA 30720-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2016 |
Last Update Date | 17/10/2016 |