Provider Demographics
NPI:1750757159
Name:EADY, GUAMEDA (APN)
Entity type:Individual
Prefix:MRS
First Name:GUAMEDA
Middle Name:
Last Name:EADY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19310 S HALSTED
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER GLENWOOD, LLC
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425
Mailing Address - Country:US
Mailing Address - Phone:708-300-3132
Mailing Address - Fax:708-300-3149
Practice Address - Street 1:19310 S HALSTED
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER GLENWOOD, LLC
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425
Practice Address - Country:US
Practice Address - Phone:708-300-3132
Practice Address - Fax:708-300-3149
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily