Provider Demographics
NPI:1902835218
Name:EILEN, HEATHER MARIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:EILEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3680 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4493
Mailing Address - Country:US
Mailing Address - Phone:513-375-9195
Mailing Address - Fax:
Practice Address - Street 1:3680 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-4493
Practice Address - Country:US
Practice Address - Phone:513-375-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC185382163W00000X
OHNA08700367500000X
GARN229884367500000X, 367500000X
WV68196367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902835218OtherTRICARE
NCP01111638OtherRAILROAD MEDICARE
NC8052506Medicaid
NC8052506Medicaid