Provider Demographics
NPI:1336750959
Name:SANDERS, EBONY NICHOLE
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:NICHOLE
Last Name:SANDERS
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:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0094
Mailing Address - Country:US
Mailing Address - Phone:919-809-0852
Mailing Address - Fax:844-246-5039
Practice Address - Street 1:312 KILGO
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-809-0852
Practice Address - Fax:844-246-5039
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172A00000X, 372600000X, 376J00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker