Provider Demographics
NPI:1831889021
Name:BANDA, EILEEN PATRICIA (LVN)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:PATRICIA
Last Name:BANDA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 EDMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2624
Mailing Address - Country:US
Mailing Address - Phone:626-203-8451
Mailing Address - Fax:
Practice Address - Street 1:4309 EDMINSTER DR
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2624
Practice Address - Country:US
Practice Address - Phone:626-203-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN714190164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse