Provider Demographics
NPI:1598482390
Name:EIDMANN, GEORGINA RAEANN (RN)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:RAEANN
Last Name:EIDMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:TOWNER
Mailing Address - State:ND
Mailing Address - Zip Code:58788-9575
Mailing Address - Country:US
Mailing Address - Phone:701-537-5800
Mailing Address - Fax:
Practice Address - Street 1:5821 PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:TOWNER
Practice Address - State:ND
Practice Address - Zip Code:58788-9575
Practice Address - Country:US
Practice Address - Phone:701-537-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NDR52550163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant