Healthcare Provider Details

I. General information

NPI: 1164692380
Provider Name (Legal Business Name): MRS. ELEANOR ROSE NEAL-EHANIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 YOAKUM COURT, 2#1016
ALEXANDRA VA
22304
US

IV. Provider business mailing address

6955 SPINNING SEED
COLUMBIA MD
21045-5314
US

V. Phone/Fax

Practice location:
  • Phone: 703-888-0217
  • Fax: 703-286-7514
Mailing address:
  • Phone: 443-832-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: