Provider Demographics
NPI:1346844081
Name:ESTHER, ELEANOR DELORES
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:DELORES
Last Name:ESTHER
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:PO BOX 2302
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2302
Mailing Address - Country:US
Mailing Address - Phone:229-456-3591
Mailing Address - Fax:
Practice Address - Street 1:707 7TH AVE NW APT B
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-3241
Practice Address - Country:US
Practice Address - Phone:229-456-3591
Practice Address - Fax:229-456-3591
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000006176376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide