Provider Demographics
NPI:1942644786
Name:EISENHOWER, NATALIE CARISA (APN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:CARISA
Last Name:EISENHOWER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CENTRE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4131
Mailing Address - Country:US
Mailing Address - Phone:856-797-2810
Mailing Address - Fax:856-797-2811
Practice Address - Street 1:106 CENTRE BLVD STE G
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4131
Practice Address - Country:US
Practice Address - Phone:856-797-2810
Practice Address - Fax:856-797-2811
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00433300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health