Kayla Ann Ebben, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

241330 Issued in WI

Practice address

N4673 Mayflower Rd
Black Creek, WI 54106-8025

Phone

(920) 757-5716

NPI assigned

Jul 25, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Kayla Ann Vandermuse Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1619521846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 COOLIDGE AVE",
            "city": "LITTLE CHUTE",
            "state": "WI",
            "postal_code": "541402340",
            "telephone_number": "920-536-0831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N4673 MAYFLOWER RD",
            "city": "BLACK CREEK",
            "state": "WI",
            "postal_code": "541068025",
            "telephone_number": "920-757-5716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBBEN",
        "first_name": "KAYLA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-25",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "241330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLA",
            "last_name": "VANDERMUSE",
            "middle_name": "ANN",
            "prefix": "MISS",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Black Creek Rescue Service
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• Michelle Leanne Draheim, RN
• Caitlin Ebben, RN
• Empower Her Therapy
• Michael Faudree, MD
• Brianna Marie Karweick
• Darrel D. Klemp, D.C.
• Thomas Emery Lornson, D.D.S.

• Registered Nurse in Black Creek, WI
• Providers in Black Creek, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.