Provider Demographics
NPI:1124451133
Name:HART, EMILY EASTBURN (ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:EASTBURN
Last Name:HART
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:EASTBURN
Other - Last Name:WALTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:7250 PARKWAY DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1388
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:
Practice Address - Street 1:7250 PARKWAY DR
Practice Address - Street 2:SUITE 500
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1388
Practice Address - Country:US
Practice Address - Phone:443-949-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43430745363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR165596OtherMD LICENSE