Provider Demographics
NPI:1851523591
Name:EISENBACH, KENNETH WILLIAM (LPN)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WILLIAM
Last Name:EISENBACH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2714
Mailing Address - Country:US
Mailing Address - Phone:419-779-2324
Mailing Address - Fax:
Practice Address - Street 1:1358 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2714
Practice Address - Country:US
Practice Address - Phone:419-779-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 130101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse