Provider Demographics
NPI:1386911485
Name:GARRISON, EBONY LIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:LIA
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:LIA
Other - Last Name:RALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6361 RIDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2258
Mailing Address - Country:US
Mailing Address - Phone:513-503-3394
Mailing Address - Fax:
Practice Address - Street 1:6361 RIDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2258
Practice Address - Country:US
Practice Address - Phone:513-503-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 144335164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse