Provider Demographics
NPI:1316488323
Name:TALLEY, EBONE L (LPN)
Entity type:Individual
Prefix:
First Name:EBONE
Middle Name:L
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 MERRIWEATHER ST NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2508
Mailing Address - Country:US
Mailing Address - Phone:234-719-9485
Mailing Address - Fax:
Practice Address - Street 1:2779 MERRIWEATHER ST NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2508
Practice Address - Country:US
Practice Address - Phone:234-719-9485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN 164558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse