Individual
BRENDA EAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20645 W HIGHWAY 62, LINCOLN, AR 72744-8796
(479) 409-0214
Mailing address
PO BOX 202, PRAIRIE GROVE, AR 72753-0202
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
050190750108E
AR
Other
Enumeration date
12/28/2011
Last updated
12/28/2011
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