Provider Demographics
NPI:1538810387
Name:EDDINGER, KATHRYN ELLA
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELLA
Last Name:EDDINGER
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 1:824 BELL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-3064
Mailing Address - Country:US
Mailing Address - Phone:585-474-5517
Mailing Address - Fax:
Practice Address - Street 1:824 BELL ST APT 3
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3064
Practice Address - Country:US
Practice Address - Phone:585-474-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000000Medicaid