Provider Demographics
NPI:1477860963
Name:EISENHART, KATHLEEN LAURA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LAURA
Last Name:EISENHART
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:76 CHURCH ST
Mailing Address - Street 2:P.O. BOX 35
Mailing Address - City:SEVEN VALLEYS
Mailing Address - State:PA
Mailing Address - Zip Code:17360-8712
Mailing Address - Country:US
Mailing Address - Phone:717-428-1330
Mailing Address - Fax:410-427-5597
Practice Address - Street 1:7601 OSLER DR
Practice Address - Street 2:6 WEST - ROOM 661
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7700
Practice Address - Country:US
Practice Address - Phone:410-427-5568
Practice Address - Fax:410-427-5597
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR054759363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health