Provider Demographics
NPI:1194408849
Name:CLINTON, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8805
Mailing Address - Country:US
Mailing Address - Phone:571-389-4872
Mailing Address - Fax:
Practice Address - Street 1:738 S MASON ST STE 3100
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807-1050
Practice Address - Country:US
Practice Address - Phone:540-568-6552
Practice Address - Fax:540-568-8096
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program