Provider Demographics
NPI:1912014515
Name:EISENBERGER, MICHELLE DARLENE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DARLENE
Last Name:EISENBERGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 SANDY CREEK RANCH HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80926-9602
Mailing Address - Country:US
Mailing Address - Phone:719-527-1213
Mailing Address - Fax:
Practice Address - Street 1:5550 SANDY CREEK RANCH HEIGHTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80926-9602
Practice Address - Country:US
Practice Address - Phone:719-527-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99227367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC71706Medicare ID - Type Unspecified