Provider Demographics
NPI:1952126302
Name:DAUGHERTY, ELDONA SAMANTHA
Entity type:Individual
Prefix:MRS
First Name:ELDONA
Middle Name:SAMANTHA
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 J ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-2157
Mailing Address - Country:US
Mailing Address - Phone:402-274-4328
Mailing Address - Fax:
Practice Address - Street 1:1829 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-1713
Practice Address - Country:US
Practice Address - Phone:402-274-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant