Provider Demographics
NPI:1093094096
Name:KELLEHER, EILEEN (RN, MSN, CNS, ACNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:RN, MSN, CNS, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PUEBLO AT BATH
Mailing Address - Street 2:TRAUMA SERVICES
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93102-0689
Mailing Address - Country:US
Mailing Address - Phone:805-259-5646
Mailing Address - Fax:
Practice Address - Street 1:PUEBLO AT BATH
Practice Address - Street 2:TRAUMA SERVICES
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93102-0689
Practice Address - Country:US
Practice Address - Phone:805-259-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721463163W00000X
CA21010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse