Provider Demographics
NPI:1538845292
Name:HAROLD, EBONY PANDORA
Entity type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:PANDORA
Last Name:HAROLD
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 1:144 SW 69TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6732
Mailing Address - Country:US
Mailing Address - Phone:580-956-4040
Mailing Address - Fax:
Practice Address - Street 1:802 SW A AVE STE B
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3934
Practice Address - Country:US
Practice Address - Phone:580-730-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator