Provider Demographics
NPI:1417121617
Name:EIZENGA, MERCY ANNE (LM, CPM)
Entity Type:Individual
Prefix:MISS
First Name:MERCY
Middle Name:ANNE
Last Name:EIZENGA
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 UTILITY RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-9114
Mailing Address - Country:US
Mailing Address - Phone:361-790-3077
Mailing Address - Fax:877-387-6064
Practice Address - Street 1:804 UTILITY RD UNIT B
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-9114
Practice Address - Country:US
Practice Address - Phone:361-790-3077
Practice Address - Fax:877-387-6064
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99061176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife