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General NPI Number Information
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NPI Number | 1417513029
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Entity Type | Individual
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Provider Name | NAOMI JEAN EISENBACK APRN
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Gender | Female
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 312 S 4TH ST STE 700
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City | LOUISVILLE
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State | KY
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Zip | 40202-3046
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | 574 DELTA RD
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City | TAYLORSVILLE
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State | KY
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Zip | 40071-9151
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Country | US
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Telephone | 502-526-7360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3013388
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License Number State | KY
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