Healthcare Provider Details

I. General information

NPI: 1962423095
Provider Name (Legal Business Name): LAURA J EISENBERG RN, MN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE 6D-1
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

12509 42ND AVE NE
SEATTLE WA
98125-4620
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-1941
  • Fax: 206-987-3946
Mailing address:
  • Phone: 206-987-1941
  • Fax: 206-987-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30004206
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: