Provider Demographics
NPI:1881058378
Name:EISENHART, MARIANNE MERCY
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:MERCY
Last Name:EISENHART
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 1:7029 SW 68TH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3123
Mailing Address - Country:US
Mailing Address - Phone:305-988-3518
Mailing Address - Fax:
Practice Address - Street 1:7029 SW 68TH CT
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3123
Practice Address - Country:US
Practice Address - Phone:305-988-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other