Provider Demographics
NPI:1740593540
Name:ELDRIDGE, VICKIE (RN)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:ELDRIDGE
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 1:211 SANTA MARIA LN
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1847
Mailing Address - Country:US
Mailing Address - Phone:614-237-4163
Mailing Address - Fax:
Practice Address - Street 1:211 SANTA MARIA LN
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-1847
Practice Address - Country:US
Practice Address - Phone:614-237-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH299639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse