Provider Demographics
NPI:1043065600
Name:FLEMING, EBONI GLENN (RN)
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:GLENN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EBONI
Other - Middle Name:ASHLEY
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1027 HILL ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-1124
Mailing Address - Country:US
Mailing Address - Phone:757-478-0568
Mailing Address - Fax:
Practice Address - Street 1:5115 HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23529-5000
Practice Address - Country:US
Practice Address - Phone:757-683-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program