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NPI Code Detail

MEDICARE: MS. NANCY EAVES APRN

MEDICARE: MS. NANCY EAVES APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner8720MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3052841OTHERLACDS
4AP10074OTHERLASTATE LICENSE

General Provider Information

NPI Number : 1255447645
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY EAVES APRN
Provider Business Mailing Address
First Line : 425 BIG BAY BLVD
Second Line :
City : LUMBERTON
State : MS
Zip : 39455-5938
Country : US
Telephone Number : 601-658-2640
Fax Number :
Provider Business Practice Location Address
First Line : 3333 UNIVERSITY AVE SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-3325
Country : US
Telephone Number : 612-767-7222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 12/06/2021

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Directions to “ MS. NANCY EAVES APRN” Practice Location

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