Provider Demographics
NPI:1679389720
Name:EBERT, RENE (LPN)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:EBERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 W SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4994
Mailing Address - Country:US
Mailing Address - Phone:623-412-4820
Mailing Address - Fax:623-412-4809
Practice Address - Street 1:7841 W SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4994
Practice Address - Country:US
Practice Address - Phone:623-412-4820
Practice Address - Fax:623-412-4809
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218036164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse