Provider Demographics
NPI:1629357017
Name:EDDY, MICHELLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:EDDY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HWY 18 SOLDIER CREEK ROAD
Mailing Address - Street 2:ROSEBUD IHS HOSPITAL
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570
Mailing Address - Country:US
Mailing Address - Phone:605-747-2231
Mailing Address - Fax:605-747-2216
Practice Address - Street 1:HWY 18 SOLDIER CREEK ROAD
Practice Address - Street 2:ROSEBUD IHS HOSPITAL
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:605-747-2216
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR034818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse