Provider Demographics
NPI:1184981722
Name:EBAI, ELIZABETH A
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:EBAI
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 1:6220 BREEZEWOOD DR
Mailing Address - Street 2:APT 202
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1128
Mailing Address - Country:US
Mailing Address - Phone:240-413-7046
Mailing Address - Fax:
Practice Address - Street 1:6220 BREEZEWOOD DR
Practice Address - Street 2:APT 202
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1128
Practice Address - Country:US
Practice Address - Phone:240-413-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCRN1046970163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide