Provider Demographics
NPI:1972803211
Name:FAULDS, EILEEN RENEE (APRNCNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:RENEE
Last Name:FAULDS
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:RENEE
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-3333
Mailing Address - Fax:614-685-3335
Practice Address - Street 1:460 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-685-3333
Practice Address - Fax:614-685-3335
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.11910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055530Medicaid
OHH023850Medicare PIN