MEDICARE: EILEEN CASTLE

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
1	390200000X	Student in an Organized Health Care Education/Training Program	1602387490	NV

General Provider Information

NPI Number	:	1649516980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN CASTLE

Provider Business Mailing Address
First Line	:	PO BOX 27077
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-1077
Country	:	US
Telephone Number	:	702-371-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 W OAKEY BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1581
Country	:	US
Telephone Number	:	702-371-9838
Fax Number	:	702-586-2057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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Directions to “ EILEEN CASTLE ” Practice Location

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