Provider Demographics
NPI:1326557984
Name:EISENMENGER, MARY BETH (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:EISENMENGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-2739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:719 E ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:NE
Practice Address - Zip Code:69034-3461
Practice Address - Country:US
Practice Address - Phone:308-364-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28597163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28597OtherRN LICENSE