Provider Demographics
NPI:1356158364
Name:WALNUM, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:WALNUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 S PINE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-2238
Mailing Address - Country:US
Mailing Address - Phone:352-628-3831
Mailing Address - Fax:352-628-3831
Practice Address - Street 1:2344 S PINE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2238
Practice Address - Country:US
Practice Address - Phone:352-628-3831
Practice Address - Fax:352-628-3831
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL693141396253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care