Healthcare Provider Details

I. General information

NPI: 1962876953
Provider Name (Legal Business Name): KATHLEEN EISENSMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 11/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST 5TH FLOOF, SCN
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

532 W PITTSBURGH ST 5TH FLOOF, SCN
GREENSBURG PA
15601-2239
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-4189
  • Fax:
Mailing address:
  • Phone: 724-832-4189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberUP005340J
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: