Provider Demographics
NPI:1477005395
Name:HIZELL, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:HIZELL
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 1:3423 15TH ST SE
Mailing Address - Street 2:102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4752
Mailing Address - Country:US
Mailing Address - Phone:202-427-6063
Mailing Address - Fax:
Practice Address - Street 1:3423 15TH ST SE
Practice Address - Street 2:102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4752
Practice Address - Country:US
Practice Address - Phone:202-427-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9463374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide