1770636615 NPI number — MRS. EILEEN SHARON WREN MSN RN

Table of content: MRS. EILEEN SHARON WREN MSN RN (NPI 1770636615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770636615 NPI number — MRS. EILEEN SHARON WREN MSN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WREN
Provider First Name:
EILEEN
Provider Middle Name:
SHARON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROWDER
Provider Other First Name:
EILEEN
Provider Other Middle Name:
SHARON
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770636615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2515 CYPRESS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-233-9477
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MCDONALD ARMY HEALTH CENTER
Provider Second Line Business Practice Location Address:
576 JEFFERSON AVE
Provider Business Practice Location Address City Name:
FORT EUSTIS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23604-5548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-314-7522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007

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: 163WC0400X , with the licence number:  0001069188 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001069188 . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".