Healthcare Provider Details

I. General information

NPI: 1902835218
Provider Name (Legal Business Name): HEATHER MARIE EILEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MARIE FARMER CRNA

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 MUIRFIELD DR
MILTON GA
30004-4493
US

IV. Provider business mailing address

3680 MUIRFIELD DR
MILTON GA
30004-4493
US

V. Phone/Fax

Practice location:
  • Phone: 513-375-9195
  • Fax:
Mailing address:
  • Phone: 513-375-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number185382
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA08700
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN229884
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: