Provider Demographics
NPI:1255946703
Name:EISWERTH, MICHELE L (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:L
Last Name:EISWERTH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:STIMECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:706 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2038
Mailing Address - Country:US
Mailing Address - Phone:845-362-3904
Mailing Address - Fax:
Practice Address - Street 1:706 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2038
Practice Address - Country:US
Practice Address - Phone:390-484-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489298163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)