Provider Demographics
NPI:1629852561
Name:EITZMANN, MEGAN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:EITZMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 450TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-7608
Mailing Address - Country:US
Mailing Address - Phone:507-525-8052
Mailing Address - Fax:
Practice Address - Street 1:11116 450TH AVE
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-7608
Practice Address - Country:US
Practice Address - Phone:507-525-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10637363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care