Provider Demographics
NPI:1902892334
Name:HOLSTEIN, ELEANOR EARLEY (CRNA)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:EARLEY
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:RUTH
Other - Last Name:EARLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 102186
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2186
Mailing Address - Country:US
Mailing Address - Phone:800-919-1190
Mailing Address - Fax:706-737-2271
Practice Address - Street 1:330 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5630
Practice Address - Country:US
Practice Address - Phone:706-802-2000
Practice Address - Fax:706-233-9846
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN087111367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000559303EMedicaid
GA000559303EMedicaid
GA43ZCBWD03Medicare ID - Type Unspecified