Provider Demographics
NPI:1730872052
Name:EASTWOOD, MILDRED ANNE (FNP APRN)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:ANNE
Last Name:EASTWOOD
Suffix:
Gender:F
Credentials:FNP APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 MARGATE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2624
Mailing Address - Country:US
Mailing Address - Phone:859-608-2943
Mailing Address - Fax:859-226-7052
Practice Address - Street 1:1661 MARGATE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2624
Practice Address - Country:US
Practice Address - Phone:859-608-2943
Practice Address - Fax:859-226-7052
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily