Provider Demographics
NPI:1609240761
Name:RAMIREZ, ELOISE TERESA
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:TERESA
Last Name:RAMIREZ
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 1:3465 NAZARETH RD
Mailing Address - Street 2:STE 102
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8359
Mailing Address - Country:US
Mailing Address - Phone:610-330-2630
Mailing Address - Fax:
Practice Address - Street 1:3465 NAZARETH RD
Practice Address - Street 2:STE 102
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8359
Practice Address - Country:US
Practice Address - Phone:610-330-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015731363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology