Provider Demographics
NPI:1891754032
Name:HART, EILEEN A (NP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:A
Last Name:HART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2687
Mailing Address - Country:US
Mailing Address - Phone:937-223-3053
Mailing Address - Fax:937-853-0166
Practice Address - Street 1:1126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2687
Practice Address - Country:US
Practice Address - Phone:937-223-3053
Practice Address - Fax:937-853-0166
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 255687363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2315453Medicaid
OHP53847Medicare UPIN
OHNP09991Medicare PIN