Provider Demographics
NPI:1891249520
Name:BELL, EBONY MARIE (PN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
Credentials:PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MEADOWDALE CT APT 308
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-2036
Mailing Address - Country:US
Mailing Address - Phone:312-721-2153
Mailing Address - Fax:
Practice Address - Street 1:108 MEADOWDALE CT APT 308
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-2036
Practice Address - Country:US
Practice Address - Phone:312-721-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.120095164W00000X
WI342266376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide