Provider Demographics
NPI:1295723039
Name:VERNON, EILEEN B (CRNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:B
Last Name:VERNON
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4434
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5424 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2904
Practice Address - Country:US
Practice Address - Phone:757-345-2170
Practice Address - Fax:757-903-4877
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2014-10-08
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Provider Licenses
StateLicense IDTaxonomies
PAUP001347B363LF0000X
VA0024168274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA008712NMRMedicare ID - Type Unspecified