Provider Demographics
NPI:1063586329
Name:EICHELBERGER, MARY J (APRN, BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:EICHELBERGER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1003
Mailing Address - Country:US
Mailing Address - Phone:414-357-5233
Mailing Address - Fax:414-357-5406
Practice Address - Street 1:9301 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1003
Practice Address - Country:US
Practice Address - Phone:414-357-5233
Practice Address - Fax:414-357-5406
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI88611-030363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology