Basic Information
| Provider Information | |||||||||
| NPI: | 1457073124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBERHARDT | ||||||||
| FirstName: | MCKAYLA | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 932909 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308544281 | ||||||||
| FaxNumber: | 3308544281 | ||||||||
| Practice Location | |||||||||
| Address1: | 1193 NORTON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442039526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308250847 | ||||||||
| FaxNumber: | 3308259569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2022 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.0032318 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.