Healthcare Provider Details

I. General information

NPI: 1417786633
Provider Name (Legal Business Name): CIERA JEAN EISELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 HAINA CT UNIT 103
WAHIAWA HI
96786-5494
US

IV. Provider business mailing address

118 HAINA CT UNIT 103
WAHIAWA HI
96786-5494
US

V. Phone/Fax

Practice location:
  • Phone: 360-204-1205
  • Fax:
Mailing address:
  • Phone: 360-204-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: