Healthcare Provider Details

I. General information

NPI: 1275504789
Provider Name (Legal Business Name): MICHELLE EISENBERGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC , EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE
FORT CARSON CA
80913-4604
US

IV. Provider business mailing address

USA MEDDAC , EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE
FORT CARSON CA
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7844
  • Fax: 719-526-7984
Mailing address:
  • Phone: 719-526-7844
  • Fax: 719-526-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number99227
License Number StateTN

VIII. Authorized Official

Name: MRS. MICHELLE EISENBERGER
Title or Position: NURSE ANESTHETIST
Credential: CRNA
Phone: 719-527-1213