Provider Demographics
NPI:1467021725
Name:EISENHARDT, TONYA (LPN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:EISENHARDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROUTE 67
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:NY
Mailing Address - Zip Code:12451-1242
Mailing Address - Country:US
Mailing Address - Phone:518-821-2150
Mailing Address - Fax:
Practice Address - Street 1:905 COUNTY BLDG
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413
Practice Address - Country:US
Practice Address - Phone:518-821-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319167-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse