Provider Demographics
NPI:1578763900
Name:EILERS, MARY ELIZABETH (APN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:EILERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LINDIG LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78636-4489
Mailing Address - Country:US
Mailing Address - Phone:830-868-2997
Mailing Address - Fax:
Practice Address - Street 1:1100 LINDIG LN
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TX
Practice Address - Zip Code:78636-4489
Practice Address - Country:US
Practice Address - Phone:830-868-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2007004259363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00462462OtherRAILROAD MEDICARE PART B
TX8K0188Medicare UPIN
TX8K1949Medicare UPIN