Healthcare Provider Details

I. General information

NPI: 1144718131
Provider Name (Legal Business Name): WHITNEY E. EADS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S DORA ST
UKIAH CA
95482-6340
US

IV. Provider business mailing address

1120 S DORA ST
UKIAH CA
95482-6340
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-2696
  • Fax:
Mailing address:
  • Phone: 707-472-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number660857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: