Provider Demographics
NPI:1609572452
Name:EGGELSTON, GLADYS M
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:M
Last Name:EGGELSTON
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 1:567 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2835
Mailing Address - Country:US
Mailing Address - Phone:419-617-5663
Mailing Address - Fax:
Practice Address - Street 1:567 S EAST ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2835
Practice Address - Country:US
Practice Address - Phone:419-617-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health