Healthcare Provider Details

I. General information

NPI: 1811467756
Provider Name (Legal Business Name): KATYA EADINGTON PILE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD STE 3100
LOS ANGELES CA
90048-3311
US

IV. Provider business mailing address

670 5TH ST APT A
HERMOSA BEACH CA
90254-4752
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-6808
  • Fax:
Mailing address:
  • Phone: 194-929-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95009418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: