Provider Demographics
NPI:1720275134
Name:WADZINSKI, EVE RABURN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:RABURN
Last Name:WADZINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 WALNUT GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-7925
Mailing Address - Country:US
Mailing Address - Phone:423-775-5512
Mailing Address - Fax:
Practice Address - Street 1:149 WALNUT GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-7925
Practice Address - Country:US
Practice Address - Phone:423-775-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics