Provider Demographics
NPI:1881664647
Name:ALTHOUSE, EILEEN MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARIE
Last Name:ALTHOUSE
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5908
Mailing Address - Fax:757-446-7055
Practice Address - Street 1:855 W BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1005
Practice Address - Country:US
Practice Address - Phone:757-446-5908
Practice Address - Fax:757-446-7055
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000803163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAN18104OtherSENTARA OPTIMA
VA010255244Medicaid
VA-033OtherTRICARE/CHAMPUS
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
VAPAROtherCIGNA
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVA HEALTH NETWORK
VAN18104OtherSENTARA OPTIMA
VAPAROtherMULTIPLAN
VA890000296Medicare PIN