Provider Demographics
NPI:1497045785
Name:EISELE, HEIDI M
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:EISELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 2ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-2500
Mailing Address - Country:US
Mailing Address - Phone:239-334-9555
Mailing Address - Fax:239-334-2439
Practice Address - Street 1:2506 2ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-2500
Practice Address - Country:US
Practice Address - Phone:239-334-9555
Practice Address - Fax:239-334-2439
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator