Provider Demographics
NPI:1083202519
Name:EISGRAU, MATT (CRNA)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:EISGRAU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 PARTRIDGE CIR UNIT B
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1872
Mailing Address - Country:US
Mailing Address - Phone:303-877-4540
Mailing Address - Fax:
Practice Address - Street 1:629 PARTRIDGE CIR UNIT B
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1872
Practice Address - Country:US
Practice Address - Phone:303-877-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO130990367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered