Provider Demographics
NPI:1770789968
Name:EAKERNS, JEANETTE ROSE (RN)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:ROSE
Last Name:EAKERNS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2974
Mailing Address - Country:US
Mailing Address - Phone:928-757-8899
Mailing Address - Fax:
Practice Address - Street 1:960 PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2974
Practice Address - Country:US
Practice Address - Phone:928-757-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN066788163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse