Individual
SANDRA J EADDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1850 TOWN CENTER PARKWAY, RESTON HOSPITAL CENTER, RESTON, VA 20190
(703) 471-0919
(703) 742-9081
Mailing address
PO BOX 2757, RESTON, VA 20195
(703) 471-0919
(703) 742-9081
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0024000023
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024000023
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010123151
—
VA
Enumeration date
01/03/2006
Last updated
04/12/2019
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