Provider Demographics
NPI:1922685163
Name:EISENHAUER, JULIE ANN (RN, CCM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:EISENHAUER
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:GREENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-2485
Mailing Address - Country:US
Mailing Address - Phone:177-534-0877
Mailing Address - Fax:
Practice Address - Street 1:827 SAGE BRUSH STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-8604
Practice Address - Country:US
Practice Address - Phone:775-340-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ254967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse