Provider Demographics
NPI:1205601648
Name:EISELE, LAUREN J
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:EISELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5438 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4325
Mailing Address - Country:US
Mailing Address - Phone:970-219-8717
Mailing Address - Fax:
Practice Address - Street 1:5438 PARADISE LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-4325
Practice Address - Country:US
Practice Address - Phone:970-219-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach