Provider Demographics
NPI:1326736661
Name:EICHENBERG, BRIDGET DEETTA (MSN, PMHNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:DEETTA
Last Name:EICHENBERG
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 MANHATTAN BLVD # 4103
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:KY
Mailing Address - Zip Code:41074-7515
Mailing Address - Country:US
Mailing Address - Phone:440-570-8793
Mailing Address - Fax:
Practice Address - Street 1:9049 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4926
Practice Address - Country:US
Practice Address - Phone:937-759-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0033712363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health