Provider Demographics
NPI:1164170775
Name:EVANS, EBONI NICOLE
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:NICOLE
Last Name:EVANS
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 1:1011 HOLDERNESS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1852
Mailing Address - Country:US
Mailing Address - Phone:513-799-0788
Mailing Address - Fax:
Practice Address - Street 1:260 NORTHLAND BLVD STE 321
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4921
Practice Address - Country:US
Practice Address - Phone:513-402-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty