Provider Demographics
NPI:1871180505
Name:WHEELER, EBONY MELLIONESE
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:MELLIONESE
Last Name:WHEELER
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 1:9420 TOWNE SQUARE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6910
Mailing Address - Country:US
Mailing Address - Phone:513-714-6306
Mailing Address - Fax:
Practice Address - Street 1:9420 TOWNE SQUARE AVE STE 2
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6910
Practice Address - Country:US
Practice Address - Phone:513-714-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker