Provider Demographics
NPI:1902139660
Name:EDDINGTON, KIM LAURA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LAURA
Last Name:EDDINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RICHARDS AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1632
Mailing Address - Country:US
Mailing Address - Phone:315-789-1784
Mailing Address - Fax:
Practice Address - Street 1:9 RICHARDS AVE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1632
Practice Address - Country:US
Practice Address - Phone:315-789-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210487-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse