Provider Demographics
NPI:1962858951
Name:EISENBISE, DAVID ALAN (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:EISENBISE
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17218 N. 72ND DR. SUITE 100,
Mailing Address - Street 2:APT B209
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9698
Mailing Address - Country:US
Mailing Address - Phone:623-334-8671
Mailing Address - Fax:623-334-8675
Practice Address - Street 1:17218 N 72ND DR STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8581
Practice Address - Country:US
Practice Address - Phone:623-334-8671
Practice Address - Fax:623-334-8675
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily