Provider Demographics
NPI:1518364025
Name:EISELE, LAUREN PETRICE (DVM)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:PETRICE
Last Name:EISELE
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 OLD HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-5530
Mailing Address - Country:US
Mailing Address - Phone:618-687-1766
Mailing Address - Fax:
Practice Address - Street 1:9351 OLD HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-5530
Practice Address - Country:US
Practice Address - Phone:618-687-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090.010318174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian