Provider Demographics
NPI:1699362897
Name:DE OLIVEIRA, EBENEZER AGUIAR
Entity Type:Individual
Prefix:
First Name:EBENEZER
Middle Name:AGUIAR
Last Name:DE OLIVEIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 PIPERS MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-3263
Mailing Address - Country:US
Mailing Address - Phone:330-361-1164
Mailing Address - Fax:
Practice Address - Street 1:5561 PIPERS MEADOW DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3263
Practice Address - Country:US
Practice Address - Phone:330-361-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant