Provider Demographics
NPI:1215435011
Name:EBURUOH, DECLAN (RN)
Entity type:Individual
Prefix:
First Name:DECLAN
Middle Name:
Last Name:EBURUOH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 WINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2219
Mailing Address - Country:US
Mailing Address - Phone:215-771-4455
Mailing Address - Fax:
Practice Address - Street 1:529 WINFIELD AVE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2219
Practice Address - Country:US
Practice Address - Phone:215-771-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN592062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse