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General NPI Number Information
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NPI Number | 1497380414
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Entity Type | Individual
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Provider Name | ANDREW EISELE
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Gender | Male
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 01/17/2021
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Provider Practice Location Address
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Address Line | 2580 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3924
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Country | US
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Telephone | 479-305-7201
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Fax | 949-577-4833
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Provider Business Mailing Address
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Address Line | 2600 E SWEETBRIAR DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6543
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Country | US
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Telephone | 479-856-8906
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 363LP0808X
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License Number State | AR
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