Provider Demographics
NPI:1134011638
Name:SMITH, EBONI LASHA (CNA)
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:LASHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WILSON PL
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-3200
Mailing Address - Country:US
Mailing Address - Phone:219-408-8732
Mailing Address - Fax:
Practice Address - Street 1:1311 WILSON PL
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-3200
Practice Address - Country:US
Practice Address - Phone:219-408-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA1704727376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide