1215910518 NPI number — MS. CHRISTINA KENDALL ESHELMAN NURSE PRACTITIONER

Table of content: MS. CHRISTINA KENDALL ESHELMAN NURSE PRACTITIONER (NPI 1215910518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215910518 NPI number — MS. CHRISTINA KENDALL ESHELMAN NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESHELMAN
Provider First Name:
CHRISTINA
Provider Middle Name:
KENDALL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215910518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2940 MAPLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMP HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011-2824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-763-1389
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 GIBNER RD
Provider Second Line Business Practice Location Address:
DUNHAM US ARMY HEALTH CLINIC
Provider Business Practice Location Address City Name:
CARLISLE BARRACKS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-245-3334
Provider Business Practice Location Address Fax Number:
717-245-3880
Provider Enumeration Date:
11/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  TP004417V , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: SP015470 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)