Healthcare Provider Details

I. General information

NPI: 1770636615
Provider Name (Legal Business Name): EILEEN SHARON WREN MSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN SHARON CROWDER RN

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCDONALD ARMY HEALTH CENTER 576 JEFFERSON AVE
FORT EUSTIS VA
23604-5548
US

IV. Provider business mailing address

2515 CYPRESS AVENUE
VIRGINIA BEACH VA
23451
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7522
  • Fax:
Mailing address:
  • Phone: 757-233-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001069188
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: