Healthcare Provider Details

I. General information

NPI: 1003209503
Provider Name (Legal Business Name): ALISON C EISSLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N. MARTIN LUTHER KING JR. BLVD SUITE 102
BALTIMORE MD
21201
US

IV. Provider business mailing address

312 N. MARTIN LUTHER KING JR. BOULEVARD SUITE 102
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 610-716-0192
  • Fax:
Mailing address:
  • Phone: 610-715-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR205878
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR205878
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: