Provider Demographics
NPI:1619523651
Name:CALDWELL, EATHELDA
Entity Type:Individual
Prefix:MRS
First Name:EATHELDA
Middle Name:
Last Name:CALDWELL
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 1:1008 PERRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-8953
Mailing Address - Country:US
Mailing Address - Phone:252-414-1745
Mailing Address - Fax:
Practice Address - Street 1:1008 PERRYTOWN RD
Practice Address - Street 2:
Practice Address - City:COLERAIN
Practice Address - State:NC
Practice Address - Zip Code:27924-8953
Practice Address - Country:US
Practice Address - Phone:252-414-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider