1114285749 NPI number — MRS. EILEEN K SOUDER CRNP

Table of content: MRS. EILEEN K SOUDER CRNP (NPI 1114285749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114285749 NPI number — MRS. EILEEN K SOUDER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUDER
Provider First Name:
EILEEN
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1114285749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 S 5TH ST STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERKASIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18944-1042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-257-8601
Provider Business Mailing Address Fax Number:
215-257-8657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 TELFORD PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TELFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18969-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-723-7833
Provider Business Practice Location Address Fax Number:
215-723-2904
Provider Enumeration Date:
05/02/2012

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: 363LF0000X , with the licence number:  SPO11914 , 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)