Provider Demographics
NPI:1366831158
Name:MANOR, EBONI (BSHS)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:MANOR
Suffix:
Gender:F
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 DEER SPRINGS WAY APT 2024
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4022
Mailing Address - Country:US
Mailing Address - Phone:702-292-0727
Mailing Address - Fax:
Practice Address - Street 1:7855 DEER SPRINGS WAY APT 2024
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4022
Practice Address - Country:US
Practice Address - Phone:702-292-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator