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NPI Code Detail

MEDICARE: EBONY NELSON

MEDICARE: EBONY NELSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1740131655
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY NELSON
Provider Business Mailing Address
First Line : 2635 PIPPIN CT
Second Line :
City : CINCINNATI
State : OH
Zip : 45231-1800
Country : US
Telephone Number : 513-653-0839
Fax Number :
Provider Business Practice Location Address
First Line : 4721 READING RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45237-6107
Country : US
Telephone Number : 513-653-0839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2026
Last Update Date : 02/05/2026

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