Provider Demographics
NPI:1588494363
Name:WEBB, EBONY NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:NICOLE
Last Name:WEBB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:NICOLE
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38201 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:TONOPAH
Mailing Address - State:AZ
Mailing Address - Zip Code:85354-7301
Mailing Address - Country:US
Mailing Address - Phone:623-474-5200
Mailing Address - Fax:
Practice Address - Street 1:38201 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:AZ
Practice Address - Zip Code:85354-7301
Practice Address - Country:US
Practice Address - Phone:623-474-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse