Provider Demographics
NPI:1548074040
Name:BRIGGS, EBONY LATICE (CNA)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:LATICE
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SYLVAN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3940
Mailing Address - Country:US
Mailing Address - Phone:616-719-6473
Mailing Address - Fax:
Practice Address - Street 1:1525 SYLVAN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3940
Practice Address - Country:US
Practice Address - Phone:616-719-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide