Provider Demographics
NPI:1972803211
Name:FAULDS, EILEEN RENEE (CNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:RENEE
Last Name:FAULDS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:RENEE
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2594
Mailing Address - Fax:614-293-4487
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203
Practice Address - Country:US
Practice Address - Phone:614-292-3800
Practice Address - Fax:614-292-1550
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.11910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055530Medicaid
OHH023850Medicare PIN