Provider Demographics
NPI:1841601705
Name:DECESARE, EILEEN (RN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:DECESARE
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 1:7619 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2625
Mailing Address - Country:US
Mailing Address - Phone:703-752-8700
Mailing Address - Fax:703-752-8779
Practice Address - Street 1:7619 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 600
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2625
Practice Address - Country:US
Practice Address - Phone:703-752-8700
Practice Address - Fax:703-752-8779
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC40015163WH0200X
VA0001076815163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health