Healthcare Provider Details

I. General information

NPI: 1306812862
Provider Name (Legal Business Name): EARLE IRWIN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 TYLER RD
CHRISTIANSBURG VA
24073-6374
US

IV. Provider business mailing address

528 NELLIES CAVE RD
BLACKSBURG VA
24060-6022
US

V. Phone/Fax

Practice location:
  • Phone: 540-731-7311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001067306
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015-000435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: