1477860963 NPI number — MRS. KATHLEEN LAURA EISENHART CRNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477860963 NPI number — MRS. KATHLEEN LAURA EISENHART CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISENHART
Provider First Name:
KATHLEEN
Provider Middle Name:
LAURA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477860963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 CHURCH ST
Provider Second Line Business Mailing Address:
P.O. BOX 35
Provider Business Mailing Address City Name:
SEVEN VALLEYS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17360-8712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-428-1330
Provider Business Mailing Address Fax Number:
410-427-5597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7601 OSLER DR
Provider Second Line Business Practice Location Address:
6 WEST - ROOM 661
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-7700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-427-5568
Provider Business Practice Location Address Fax Number:
410-427-5597
Provider Enumeration Date:
09/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R054759 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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