Provider Demographics
NPI:1073888640
Name:EAGLIN, SHERRETTA RENIA
Entity Type:Individual
Prefix:MRS
First Name:SHERRETTA
Middle Name:RENIA
Last Name:EAGLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 39TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2105
Mailing Address - Country:US
Mailing Address - Phone:409-962-1300
Mailing Address - Fax:409-962-0715
Practice Address - Street 1:4845 39TH ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2105
Practice Address - Country:US
Practice Address - Phone:409-962-1300
Practice Address - Fax:409-962-0715
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health