Provider Demographics
NPI:1851430706
Name:MATHESON, EDEN LOVONE (RN COMMUNITY HEALTH)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:LOVONE
Last Name:MATHESON
Suffix:
Gender:F
Credentials:RN COMMUNITY HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:LAUREL BLOOMERY
Mailing Address - State:TN
Mailing Address - Zip Code:37680-0235
Mailing Address - Country:US
Mailing Address - Phone:423-727-9731
Mailing Address - Fax:423-727-4153
Practice Address - Street 1:715 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1217
Practice Address - Country:US
Practice Address - Phone:423-727-9731
Practice Address - Fax:423-727-4153
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000141565163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health