MEDICARE: ARREY I EYONGHEROK FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP.CNP.021963	OH
2	363LF0000X	Family Nurse Practitioner	ARNP.CNP.021963	OH

General Provider Information

NPI Number	:	1205343936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARREY I EYONGHEROK FNP

Provider Business Mailing Address
First Line	:	3067 CHAMBERLIN DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-3742
Country	:	US
Telephone Number	:	937-329-7978
Fax Number	:

Provider Business Practice Location Address
First Line	:	2773 ORCHARD RUN RD
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-2831
Country	:	US
Telephone Number	:	937-734-8333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	09/08/2024

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