Healthcare Provider Details

I. General information

NPI: 1386025005
Provider Name (Legal Business Name): DARCI LEE EIGENBERG R.T (R)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 HECKMAN CT
SAINT JAMES MN
56081-8702
US

IV. Provider business mailing address

1344 5TH AVE
WINDOM MN
56101-1428
US

V. Phone/Fax

Practice location:
  • Phone: 507-375-9670
  • Fax:
Mailing address:
  • Phone: 507-993-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number538836
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: