Healthcare Provider Details

I. General information

NPI: 1316541709
Provider Name (Legal Business Name): ANNA ELIZABETH RACHEL EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPAA QUARRY PL
KAILUA HI
96734
US

IV. Provider business mailing address

1216 VALDOSTA DR
FORT WAYNE IN
46825-3540
US

V. Phone/Fax

Practice location:
  • Phone: 808-741-2232
  • Fax:
Mailing address:
  • Phone: 260-633-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: