1306976006 NPI number — MS. EILEEN RUDEGEAIR ERSKINE CRNP

Table of content: MS. EILEEN RUDEGEAIR ERSKINE CRNP (NPI 1306976006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306976006 NPI number — MS. EILEEN RUDEGEAIR ERSKINE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERSKINE
Provider First Name:
EILEEN
Provider Middle Name:
RUDEGEAIR
Provider Name Prefix Text:
MS.
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:
1306976006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12510 PROSPERITY DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20904-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-485-5210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 KNOLL NORTH DRIVE
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-730-9363
Provider Business Practice Location Address Fax Number:
410-730-2084
Provider Enumeration Date:
03/06/2007

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: 363L00000X , with the licence number:  R097607 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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