Provider Demographics
NPI:1467196626
Name:MINOR, EBONY LATREASE
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:LATREASE
Last Name:MINOR
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 1:101 BLAIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2813
Mailing Address - Country:US
Mailing Address - Phone:937-520-3335
Mailing Address - Fax:
Practice Address - Street 1:101 BLAIRWOOD DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-2813
Practice Address - Country:US
Practice Address - Phone:937-520-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide