Provider Demographics
NPI:1538323852
Name:EFFIONG, EDIMA BASSEY (LVN)
Entity Type:Individual
Prefix:MISS
First Name:EDIMA
Middle Name:BASSEY
Last Name:EFFIONG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:EDIMA
Other - Middle Name:
Other - Last Name:ASUQUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 WIER RD
Mailing Address - Street 2:APT 7
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3865
Mailing Address - Country:US
Mailing Address - Phone:909-465-3863
Mailing Address - Fax:
Practice Address - Street 1:380 WIER RD
Practice Address - Street 2:APT 7
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3865
Practice Address - Country:US
Practice Address - Phone:909-465-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN210743164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse