Provider Demographics
NPI:1467108506
Name:PRINGLE, EBONEE JORDAN
Entity Type:Individual
Prefix:
First Name:EBONEE
Middle Name:JORDAN
Last Name:PRINGLE
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 1:1737 MORRIS AVE NE APT D
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-3373
Mailing Address - Country:US
Mailing Address - Phone:330-760-9726
Mailing Address - Fax:
Practice Address - Street 1:1737 MORRIS AVE NE APT D
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3373
Practice Address - Country:US
Practice Address - Phone:330-760-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401100900610376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide