Provider Demographics
NPI:1548213614
Name:EISENBERG, BARBARA L (ARNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13539 NORTHSHIRE RD NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4033
Mailing Address - Country:US
Mailing Address - Phone:206-788-6226
Mailing Address - Fax:206-363-5348
Practice Address - Street 1:406 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045
Practice Address - Country:US
Practice Address - Phone:425-333-6924
Practice Address - Fax:425-333-6909
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9636374Medicaid
WA2160EIOtherBSWA
WA0203911OtherLIWA
WAG8862441Medicare PIN
WAP00378922Medicare PIN
WA2160EIOtherBSWA
WA8TA038Medicare PIN