Healthcare Provider Details

I. General information

NPI: 1568288090
Provider Name (Legal Business Name): EILEEN BYRNE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11886 HEALING WAY STE 701
SILVER SPRING MD
20904-7917
US

IV. Provider business mailing address

1800 S HANOVER ST APT 119
BALTIMORE MD
21230-4979
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-3216
  • Fax: 832-601-6868
Mailing address:
  • Phone: 732-425-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR233677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: