Provider Demographics
NPI:1093488603
Name:NEBBITT, EBONY NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:NICOLE
Last Name:NEBBITT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 LANSING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3456
Mailing Address - Country:US
Mailing Address - Phone:314-379-8611
Mailing Address - Fax:
Practice Address - Street 1:3170 LANSING DR
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3456
Practice Address - Country:US
Practice Address - Phone:314-379-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009021777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse