Provider Demographics
NPI:1770636615
Name:WREN, EILEEN SHARON (MSN RN)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:SHARON
Last Name:WREN
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:SHARON
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2515 CYPRESS AVENUE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451
Mailing Address - Country:US
Mailing Address - Phone:757-233-9477
Mailing Address - Fax:
Practice Address - Street 1:MCDONALD ARMY HEALTH CENTER
Practice Address - Street 2:576 JEFFERSON AVE
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001069188163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001069188OtherREGISTERED NURSE LICENSE