Provider Demographics
NPI:1669680286
Name:DUBE, EUNICE (RN)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:DUBE
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 1:12235 LITTLE PATUXENT PKWY
Mailing Address - Street 2:# C.
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2875
Mailing Address - Country:US
Mailing Address - Phone:410-887-0246
Mailing Address - Fax:410-887-0243
Practice Address - Street 1:1538 COUNTRY RIDGE LN
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3906
Practice Address - Country:US
Practice Address - Phone:410-887-0246
Practice Address - Fax:410-887-0243
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR139039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse