Healthcare Provider Details

I. General information

NPI: 1881054302
Provider Name (Legal Business Name): EASTERN MENNONITE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PARK RD
HARRISONBURG VA
22802-2404
US

IV. Provider business mailing address

1200 PARK RD
HARRISONBURG VA
22802-2404
US

V. Phone/Fax

Practice location:
  • Phone: 540-432-4308
  • Fax: 540-432-4099
Mailing address:
  • Phone: 540-432-4308
  • Fax: 540-432-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number207Q00000X
License Number StateVA

VIII. Authorized Official

Name: MRS. IRENE H. KNISS
Title or Position: DIRECTOR OF HEALTH SERVICES
Credential: RN BSN
Phone: 540-432-4302