Provider Demographics
NPI:1144859976
Name:EZELL, CIELITA
Entity type:Individual
Prefix:
First Name:CIELITA
Middle Name:
Last Name:EZELL
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 1:6300 GRELOT RD # STG1235
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3602
Mailing Address - Country:US
Mailing Address - Phone:251-509-8641
Mailing Address - Fax:251-385-5561
Practice Address - Street 1:6300 GRELOT RD # STG1235
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3602
Practice Address - Country:US
Practice Address - Phone:251-509-8641
Practice Address - Fax:251-385-5561
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2022-02-18
Deactivation Date:2021-11-01
Deactivation Code:
Reactivation Date:2021-12-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide