Provider Demographics
NPI:1407036031
Name:DOWTIN, ELOISE M (RN)
Entity Type:Individual
Prefix:MS
First Name:ELOISE
Middle Name:M
Last Name:DOWTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26153
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-6153
Mailing Address - Country:US
Mailing Address - Phone:919-349-5540
Mailing Address - Fax:919-255-1775
Practice Address - Street 1:303 AQUA MARINE LN
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7870
Practice Address - Country:US
Practice Address - Phone:919-349-5540
Practice Address - Fax:919-255-1775
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-654320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness