Provider Demographics
NPI:1083232797
Name:EISENBERG, HATICHA ATAHANOVNA (FNP)
Entity Type:Individual
Prefix:
First Name:HATICHA
Middle Name:ATAHANOVNA
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3689
Mailing Address - Country:US
Mailing Address - Phone:617-939-3948
Mailing Address - Fax:
Practice Address - Street 1:6 JFK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4909
Practice Address - Country:US
Practice Address - Phone:617-939-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000000000OtherOTHER