Provider Demographics
NPI:1710076153
Name:EISNAUGLE, NATALIE NICHOL (STNA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICHOL
Last Name:EISNAUGLE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 PRINCETON LN
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9038
Mailing Address - Country:US
Mailing Address - Phone:614-409-0423
Mailing Address - Fax:
Practice Address - Street 1:5333 PRINCETON LN
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9038
Practice Address - Country:US
Practice Address - Phone:614-409-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400538280906376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2681638Medicaid