Provider Demographics
NPI:1447840780
Name:EDDLEMAN, JEANNINE R (RN)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:R
Last Name:EDDLEMAN
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 1:702 STEAMBOAT STA
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4174
Mailing Address - Country:US
Mailing Address - Phone:267-984-6666
Mailing Address - Fax:
Practice Address - Street 1:702 STEAMBOAT STA
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4174
Practice Address - Country:US
Practice Address - Phone:267-984-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA584139163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice