Provider Demographics
NPI:1073275087
Name:LIGHT, EVA KATHRYN (CNA)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:KATHRYN
Last Name:LIGHT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 SNOWFALL DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3709
Mailing Address - Country:US
Mailing Address - Phone:571-621-2067
Mailing Address - Fax:
Practice Address - Street 1:8190 SNOWFALL DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-3709
Practice Address - Country:US
Practice Address - Phone:571-621-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401211512376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide