Provider Demographics
NPI:1184745846
Name:EASTMAN, KAREN SUE (RDLDN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:RDLDN
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:STORRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LDN
Mailing Address - Street 1:590 STARBOARD DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4144
Mailing Address - Country:US
Mailing Address - Phone:239-734-2600
Mailing Address - Fax:239-263-2351
Practice Address - Street 1:590 STARBOARD DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4144
Practice Address - Country:US
Practice Address - Phone:239-734-2600
Practice Address - Fax:239-263-2351
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered