Provider Demographics
NPI:1386829646
Name:EISEMANN, MARYANN SOLT (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:SOLT
Last Name:EISEMANN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 PRINCESS ANNE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7526
Mailing Address - Country:US
Mailing Address - Phone:570-263-0555
Mailing Address - Fax:904-638-4765
Practice Address - Street 1:4605 PRINCESS ANNE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7526
Practice Address - Country:US
Practice Address - Phone:570-263-0555
Practice Address - Fax:904-638-4765
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9368677163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant