Provider Demographics
NPI:1457176752
Name:LARD, EBONI LOVE
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:LOVE
Last Name:LARD
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 1:5414 ISABEL CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5410
Mailing Address - Country:US
Mailing Address - Phone:630-936-7410
Mailing Address - Fax:
Practice Address - Street 1:5414 ISABEL CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5410
Practice Address - Country:US
Practice Address - Phone:630-936-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty