Provider Demographics
NPI:1649989435
Name:EBUA, MARIVON BEI
Entity type:Individual
Prefix:
First Name:MARIVON
Middle Name:BEI
Last Name:EBUA
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 1:6945 ELLEN BOAT LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7913
Mailing Address - Country:US
Mailing Address - Phone:443-251-8030
Mailing Address - Fax:
Practice Address - Street 1:6945 ELLEN BOAT LN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7913
Practice Address - Country:US
Practice Address - Phone:443-251-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide