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NPI Code Detail

MEDICARE: EARLE IRWIN CNS

MEDICARE: EARLE IRWIN CNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse0001067306VA
2364SP0809XAdult Psychiatric/Mental Health Clinical Nurse Specialist0015-000435VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306812862
Entity Type Code : Individual
Provider Name (Legal Business Name) : EARLE IRWIN CNS
Provider Business Mailing Address
First Line : 528 NELLIES CAVE RD
Second Line :
City : BLACKSBURG
State : VA
Zip : 24060-6022
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2900 TYLER RD
Second Line :
City : CHRISTIANSBURG
State : VA
Zip : 24073-6374
Country : US
Telephone Number : 540-731-7311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 06/13/2008

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