Healthcare Provider Details

I. General information

NPI: 1609817808
Provider Name (Legal Business Name): VICTORIA LYNN EADES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 INGLEWOOD DRIVE
CRAWFORDSVILLE IN
47933
US

IV. Provider business mailing address

807 E MARKET ST
CRAWFORDSVILLE IN
47933-1941
US

V. Phone/Fax

Practice location:
  • Phone: 765-361-9767
  • Fax: 765-361-0374
Mailing address:
  • Phone: 765-361-9767
  • Fax: 765-361-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number28156687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: