Provider Demographics
NPI:1124601497
Name:AYEBALE, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:AYEBALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 WHEELER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1241
Mailing Address - Country:US
Mailing Address - Phone:347-854-6370
Mailing Address - Fax:
Practice Address - Street 1:2378 WHEELER ST APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1241
Practice Address - Country:US
Practice Address - Phone:347-854-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH459847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse