Provider Demographics
NPI:1710270673
Name:EISENBRAUN-LONG, LISA A (PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:EISENBRAUN-LONG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12245 W HIGH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85736-1625
Mailing Address - Country:US
Mailing Address - Phone:520-250-8243
Mailing Address - Fax:
Practice Address - Street 1:12245 W HIGH RIDGE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85736-1625
Practice Address - Country:US
Practice Address - Phone:520-250-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201140479RN163W00000X
OR201608197NP-PP363LP0808X
AZ235007363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse