Provider Demographics
NPI:1245582006
Name:EASTMAN, ADELE LOUISE (LVN)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:LOUISE
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1214
Mailing Address - Country:US
Mailing Address - Phone:559-444-3458
Mailing Address - Fax:
Practice Address - Street 1:2633 N 2ND ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1214
Practice Address - Country:US
Practice Address - Phone:559-444-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVM267641164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse