Provider Demographics
NPI:1275025074
Name:SANA, EDEN DATA
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:DATA
Last Name:SANA
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 1:2818 CURRY PKWY APT 3
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2806
Mailing Address - Country:US
Mailing Address - Phone:608-628-6850
Mailing Address - Fax:
Practice Address - Street 1:2818 CURRY PKWY APT 3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2806
Practice Address - Country:US
Practice Address - Phone:608-628-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIRN9482951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse