Basic Information
| Provider Information | |||||||||
| NPI: | 1508593856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRIEBEL | ||||||||
| FirstName: | ELEANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 W BROOKE AVE | ||||||||
| Address2: | |||||||||
| City: | MAGNOLIA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080491302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569387378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 HADDON AVE | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081033101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567573500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2022 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.