Healthcare Provider Details

I. General information

NPI: 1336688183
Provider Name (Legal Business Name): EBONY WALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7122 EASTLAWN DR APT 3
CINCINNATI OH
45237-4141
US

IV. Provider business mailing address

7122 EASTLAWN DR APT 3
CINCINNATI OH
45237-4141
US

V. Phone/Fax

Practice location:
  • Phone: 513-693-3512
  • Fax:
Mailing address:
  • Phone: 513-693-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number154727
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number154727
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number154727
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number154727
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: