Provider Demographics
NPI:1659325223
Name:EILAND, BERTHA JANENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:JANENE
Last Name:EILAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:JANENE
Other - Last Name:HALFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:400 N BROWN ST BLDG 1
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-1518
Mailing Address - Country:US
Mailing Address - Phone:254-386-1600
Mailing Address - Fax:254-386-5173
Practice Address - Street 1:104 WALNUT STREET
Practice Address - Street 2:HICO CLINIC
Practice Address - City:HICO
Practice Address - State:TX
Practice Address - Zip Code:76457-0230
Practice Address - Country:US
Practice Address - Phone:254-796-4224
Practice Address - Fax:254-386-4064
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ64897Medicare UPIN
TX388460ZK2GMedicare PIN