Provider Demographics
NPI:1285603332
Name:CEPONIS, EILEEN MARIE (FNP C)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:CEPONIS
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DOCTORS CIR
Mailing Address - Street 2:HANOVER MEDICAL SPECIALISTS, PA
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7403
Mailing Address - Country:US
Mailing Address - Phone:910-763-5182
Mailing Address - Fax:910-763-0291
Practice Address - Street 1:1515 DOCTORS CIR
Practice Address - Street 2:HANOVER MEDICAL SPECIALISTS, PA
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-763-5182
Practice Address - Fax:910-763-0291
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201980363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592403FMedicare ID - Type Unspecified
P46651Medicare UPIN