Provider Demographics
NPI:1871580928
Name:LENNOX, EILEEN MCDONALD (NP, BC)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:MCDONALD
Last Name:LENNOX
Suffix:
Gender:F
Credentials:NP, BC
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:ANN
Other - Last Name:LENNOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP, BC
Mailing Address - Street 1:4201 S WASHINGTON ST
Mailing Address - Street 2:IWU HEALTH CENTER, STUDENT CENTER #210
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4974
Mailing Address - Country:US
Mailing Address - Phone:765-677-2206
Mailing Address - Fax:765-677-2849
Practice Address - Street 1:4201 S WASHINGTON ST
Practice Address - Street 2:IWU HEALTH CENTER, STUDENT CENTER #210
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4974
Practice Address - Country:US
Practice Address - Phone:765-677-2206
Practice Address - Fax:765-677-2849
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000247A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000312417OtherBLUE CROSS