Healthcare Provider Details

I. General information

NPI: 1669384665
Provider Name (Legal Business Name): DANA EISNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

IV. Provider business mailing address

303 W COVENTRY CT APT 218
GLENDALE WI
53217-3984
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7300
  • Fax:
Mailing address:
  • Phone: 414-721-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number18842-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: