Provider Demographics
NPI:1003638073
Name:MYERS, EULAMAE RUTLEDGE
Entity type:Individual
Prefix:
First Name:EULAMAE
Middle Name:RUTLEDGE
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CLEVELAND PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6529
Mailing Address - Country:US
Mailing Address - Phone:757-718-3675
Mailing Address - Fax:757-321-8837
Practice Address - Street 1:370 CLEVELAND PL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6529
Practice Address - Country:US
Practice Address - Phone:757-718-3675
Practice Address - Fax:757-321-8837
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA60802006251C00000X
VA60802008251C00000X
VA60808011253Z00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care