Provider Demographics
NPI:1962423095
Name:EISENBERG, LAURA J (RN, MN, FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:RN, MN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 42ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4620
Mailing Address - Country:US
Mailing Address - Phone:206-987-1941
Mailing Address - Fax:206-987-3946
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:6D-1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-1941
Practice Address - Fax:206-987-3946
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004206363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP988WAMedicaid
WA9627928Medicaid
WAAB20985Medicare ID - Type Unspecified
AKNP988WAMedicaid