Provider Demographics
NPI:1558313163
Name:EITEL, JEFFREY (RN,GNP-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:EITEL
Suffix:
Gender:M
Credentials:RN,GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 S SAM HOUSTON PKWY E
Mailing Address - Street 2:101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4857
Mailing Address - Country:US
Mailing Address - Phone:713-343-2300
Mailing Address - Fax:866-546-1237
Practice Address - Street 1:8511 S SAM HOUSTON PKWY E
Practice Address - Street 2:101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4857
Practice Address - Country:US
Practice Address - Phone:713-343-2300
Practice Address - Fax:866-546-1237
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616018363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174666101Medicaid
TX8D8058Medicare ID - Type UnspecifiedMEDICARE
TX174666101Medicaid