Provider Demographics
NPI:1710193743
Name:EISENHAUER, WALTER A (PA-C)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:A
Last Name:EISENHAUER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7133 NITTANY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-9013
Mailing Address - Country:US
Mailing Address - Phone:570-726-7992
Mailing Address - Fax:570-726-6554
Practice Address - Street 1:955 BELLEFONTE AVE
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3033
Practice Address - Country:US
Practice Address - Phone:570-748-7714
Practice Address - Fax:570-893-6325
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000816L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA144586Medicare PIN