Provider Demographics
NPI:1558910984
Name:EISENHAUER, MICHELLE LEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEE
Last Name:EISENHAUER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:RUDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-0142
Mailing Address - Country:US
Mailing Address - Phone:732-674-6639
Mailing Address - Fax:
Practice Address - Street 1:10 STOCKTON DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6433
Practice Address - Country:US
Practice Address - Phone:732-363-6655
Practice Address - Fax:732-363-6656
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00956300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily