Provider Demographics
NPI:1457112096
Name:STANTON, EBONE
Entity Type:Individual
Prefix:
First Name:EBONE
Middle Name:
Last Name:STANTON
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 1:619 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-2203
Mailing Address - Country:US
Mailing Address - Phone:412-626-0434
Mailing Address - Fax:
Practice Address - Street 1:150 IDA AVE
Practice Address - Street 2:
Practice Address - City:DONORA
Practice Address - State:PA
Practice Address - Zip Code:15033-1224
Practice Address - Country:US
Practice Address - Phone:412-626-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050429021012R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty