Provider Demographics
NPI:1063990786
Name:CALDWELL, EBONY EUGEINA
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:EUGEINA
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 YELLOW BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2402
Mailing Address - Country:US
Mailing Address - Phone:702-572-9990
Mailing Address - Fax:
Practice Address - Street 1:2001 S JONES BLVD # E3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3182
Practice Address - Country:US
Practice Address - Phone:702-425-3377
Practice Address - Fax:702-997-7552
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X, 372600000X, 3747A0650X, 376J00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider