Provider Demographics
NPI:1598547390
Name:BEAL, EBONY N
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:N
Last Name:BEAL
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 1:2765 NEW MADRID LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2600
Mailing Address - Country:US
Mailing Address - Phone:314-371-8156
Mailing Address - Fax:
Practice Address - Street 1:2765 NEW MADRID LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2600
Practice Address - Country:US
Practice Address - Phone:314-371-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care