Provider Demographics
NPI:1821178302
Name:EISENREICH, ROBIN NICOLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:NICOLE
Last Name:EISENREICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:NICOLE
Other - Last Name:RADICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2173363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23633069Medicaid
CO023890OtherKAISER COMMERCIAL NUMBER
CO023890OtherKAISER COMMERCIAL NUMBER
COQ58377Medicare UPIN