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General NPI Number Information
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NPI Number | 1609408210
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Entity Type | Individual
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Provider Name | JENNA RAE EISOLD CPNP
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Gender | Female
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 65 W WOOD RIDGE DR
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City | RIVER FALLS
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State | WI
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Zip | 54022-8291
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Country | US
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Telephone | 763-229-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 65 W WOOD RIDGE DR
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City | RIVER FALLS
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State | WI
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Zip | 54022-8291
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Country | US
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Telephone | 763-229-3744
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 7231
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License Number State | MN
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