Healthcare Provider Details

I. General information

NPI: 1285208793
Provider Name (Legal Business Name): EBONY J BECKLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 E 25TH ST
BALTIMORE MD
21218-5304
US

IV. Provider business mailing address

6509 COPPER RIDGE DR APT 201
BALTIMORE MD
21209-2285
US

V. Phone/Fax

Practice location:
  • Phone: 410-617-0142
  • Fax: 443-563-2143
Mailing address:
  • Phone: 443-202-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR211296
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR211296
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR211296
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR211296
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR211296
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: