Individual
EBONY T SALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3921 W BASELINE RD, LAVEEN, AZ 85339-1801
(623) 606-7532
Mailing address
250 APPLEWOOD DR UNIT 3004, LAWRENCEVILLE, GA 30046-6409
(623) 606-7532
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN092214
GA
Other
Enumeration date
01/27/2025
Last updated
01/27/2025
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