Provider Demographics
NPI:1043856503
Name:ANDREWS, EILEEN LAVERNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:LAVERNE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 W WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4129
Mailing Address - Country:US
Mailing Address - Phone:602-703-6216
Mailing Address - Fax:
Practice Address - Street 1:3348 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2499
Practice Address - Country:US
Practice Address - Phone:602-455-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN055793163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty