Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 40725 | KY |
N | 2080P0204X | Pediatric Emergency Doctor | 40725 | KY |
NPI | 1285776054 |
---|---|
Provider Name | Dr. Bernadette Veza Eaton |
First Address | Louisville, KY 40201-2469 |
Second Address | Louisville, KY 40202-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 11/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200886380 | (05) | IN |
7100008630 | (05) | KY |