Provider Demographics
NPI:1457591620
Name:EDDY, LISA A (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:EDDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7434 MARVIN HILL RD
Mailing Address - Street 2:B
Mailing Address - City:SPRINGWATER
Mailing Address - State:NY
Mailing Address - Zip Code:14560-9723
Mailing Address - Country:US
Mailing Address - Phone:585-519-7571
Mailing Address - Fax:
Practice Address - Street 1:7434 MARVIN HILL RD
Practice Address - Street 2:B
Practice Address - City:SPRINGWATER
Practice Address - State:NY
Practice Address - Zip Code:14560-9723
Practice Address - Country:US
Practice Address - Phone:585-519-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210868164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse