Provider Demographics
NPI:1740559517
Name:EUNICE, HEATHER MAYE (LVN)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MAYE
Last Name:EUNICE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 SAXONVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4400
Mailing Address - Country:US
Mailing Address - Phone:916-671-0892
Mailing Address - Fax:916-338-3366
Practice Address - Street 1:3234 SAXONVILLE WAY
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4400
Practice Address - Country:US
Practice Address - Phone:916-671-0892
Practice Address - Fax:916-338-3366
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN225680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse