Provider Demographics
NPI:1255178463
Name:ELDRIDGE, DAWNISHA T
Entity type:Individual
Prefix:
First Name:DAWNISHA
Middle Name:T
Last Name:ELDRIDGE
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 1:7584 PENNYCROFT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8758
Mailing Address - Country:US
Mailing Address - Phone:317-939-8441
Mailing Address - Fax:
Practice Address - Street 1:304 PARK CREEK LN
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-0075
Practice Address - Country:US
Practice Address - Phone:317-721-9102
Practice Address - Fax:317-855-1906
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-107521-1251E00000X, 253Z00000X
IN24-10752101376J00000X
IN24-017521-1376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty