Provider Demographics
NPI:1649960063
Name:PEAKE, EBONY V
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:V
Last Name:PEAKE
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 1:3665 KIPP CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-2108
Mailing Address - Country:US
Mailing Address - Phone:937-613-4621
Mailing Address - Fax:
Practice Address - Street 1:3665 KIPP CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-2108
Practice Address - Country:US
Practice Address - Phone:937-613-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide