MEDICARE: MS. MICHELLE DARLENE EISENBERGER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	99227	CO

General Provider Information

NPI Number	:	1912014515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE DARLENE EISENBERGER CRNA

Provider Business Mailing Address
First Line	:	5550 SANDY CREEK RANCH HEIGHTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9602
Country	:	US
Telephone Number	:	719-527-1213
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 SANDY CREEK RANCH HEIGHTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9602
Country	:	US
Telephone Number	:	719-527-1213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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