Provider Demographics
NPI:1467346957
Name:DISTELRATH, EILEEN MARIE (RN)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:DISTELRATH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARIE
Other - Last Name:LANCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EILEEN LANCZYNSKI
Mailing Address - Street 1:518 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-1313
Mailing Address - Country:US
Mailing Address - Phone:989-233-6727
Mailing Address - Fax:
Practice Address - Street 1:1040 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5516
Practice Address - Country:US
Practice Address - Phone:810-257-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704316006163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health