Provider Demographics
NPI:1639995194
Name:MONROE, EBONY NICOLE
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:NICOLE
Last Name:MONROE
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 1:41390 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3404
Mailing Address - Country:US
Mailing Address - Phone:313-938-5578
Mailing Address - Fax:
Practice Address - Street 1:41390 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3404
Practice Address - Country:US
Practice Address - Phone:313-938-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health