Healthcare Provider Details

I. General information

NPI: 1558529024
Provider Name (Legal Business Name): CHRISTINE GILMORE EUBANKS PH.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 NORTH 11TH ST. NELSON CLINIC RM 304
RICHMOND VA
23298-0150
US

IV. Provider business mailing address

403 NORTH 11TH ST. PO BOX 980150
RICHMOND VA
23298-0150
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0431
  • Fax: 804-628-0950
Mailing address:
  • Phone: 804-828-0431
  • Fax: 804-628-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1903
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001368
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: