Provider Demographics
NPI:1386025005
Name:EIGENBERG, DARCI LEE (RT (R))
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:LEE
Last Name:EIGENBERG
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1428
Mailing Address - Country:US
Mailing Address - Phone:507-993-6707
Mailing Address - Fax:
Practice Address - Street 1:1212 HECKMAN CT
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-8702
Practice Address - Country:US
Practice Address - Phone:507-375-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN538836247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist