Basic Information
| Provider Information | |||||||||
| NPI: | 1962662619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBBERT | ||||||||
| FirstName: | RENEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34TH AND CIVIC CENTER BLVD | ||||||||
| Address2: | CHILDRENS HOSPITAL OF PHILADELPHIA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 34TH AND CIVIC CENTER BLVD | ||||||||
| Address2: | CHILDRENS HOSPITAL OF PHILADELPHIA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN531390 | PA | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WN0002X | SP009230 | PA | Y | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care |
No ID Information.