Basic Information
| Provider Information | |||||||||
| NPI: | 1386952919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EBNER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | R.N. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VANBUREN | ||||||||
| OtherFirstName: | SUSAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 150 TEJAS PL | ||||||||
| Address2: | PO BOX 430 | ||||||||
| City: | NIPOMO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934449123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059293211 | ||||||||
| FaxNumber: | 8059296440 | ||||||||
| Practice Location | |||||||||
| Address1: | 1418 E MAIN ST | ||||||||
| Address2: | STE 210 | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934544833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059283678 | ||||||||
| FaxNumber: | 8059286408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 279839 | CA | N | Nursing Service Providers | Registered Nurse | 164W00000X | 1127 | CA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.