Provider Demographics
NPI:1710795000
Name:EAGLEBURGER, ALICIA (RMA)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:EAGLEBURGER
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 FITZ LN
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8459
Mailing Address - Country:US
Mailing Address - Phone:417-233-1262
Mailing Address - Fax:417-233-1260
Practice Address - Street 1:1919 FITZ LN
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8459
Practice Address - Country:US
Practice Address - Phone:417-233-1262
Practice Address - Fax:417-233-1260
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2847341374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician