Provider Demographics
NPI:1437985611
Name:EADES, VICTORIA (FNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:EADES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-9298
Mailing Address - Country:US
Mailing Address - Phone:217-530-5566
Mailing Address - Fax:
Practice Address - Street 1:1190 E 2900 NORTH RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:IL
Practice Address - Zip Code:60927-7103
Practice Address - Country:US
Practice Address - Phone:217-530-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine