Healthcare Provider Details

I. General information

NPI: 1467346957
Provider Name (Legal Business Name): EILEEN MARIE DISTELRATH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN MARIE LANCZYNSKI EILEEN LANCZYNSKI

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

IV. Provider business mailing address

518 CHURCH ST
CHESANING MI
48616-1313
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3705
  • Fax:
Mailing address:
  • Phone: 989-233-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704316006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: