Provider Demographics
NPI:1528209012
Name:EISENHAUER, TAMMY S (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:EISENHAUER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:S
Other - Last Name:WALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1015 GREAT HALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-507-8495
Mailing Address - Fax:717-274-9746
Practice Address - Street 1:166 SOUTH NEW HOLLAND ROAD
Practice Address - Street 2:
Practice Address - City:KINZERS
Practice Address - State:PA
Practice Address - Zip Code:17535-5600
Practice Address - Country:US
Practice Address - Phone:717-299-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010231363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102276709Medicaid
PA154207Medicare PIN