Provider Demographics
NPI:1497268270
Name:WEBSTER, EBONY (LPN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 OLIVE TREE DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1311
Mailing Address - Country:US
Mailing Address - Phone:937-304-8877
Mailing Address - Fax:
Practice Address - Street 1:5570 OLIVE TREE DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1311
Practice Address - Country:US
Practice Address - Phone:937-304-8877
Practice Address - Fax:937-304-8877
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH112135M164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse