Healthcare Provider Details

I. General information

NPI: 1811467475
Provider Name (Legal Business Name): HERMINIA EADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E. SUNSET RD., #17 BLDG B
LAS VEGAS NV
89120-3508
US

IV. Provider business mailing address

2700 E. SUNSET RD., #17 BLDG B
LAS VEGAS NV
89120-3508
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-8809
  • Fax:
Mailing address:
  • Phone: 702-476-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number7854PCS3
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: