Provider Demographics
NPI:1962876953
Name:EISENSMITH, KATHLEEN (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:EISENSMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 W PITTSBURGH ST
Mailing Address - Street 2:5TH FLOOF, SCN
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2239
Mailing Address - Country:US
Mailing Address - Phone:724-832-4189
Mailing Address - Fax:
Practice Address - Street 1:532 W PITTSBURGH ST
Practice Address - Street 2:5TH FLOOF, SCN
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2239
Practice Address - Country:US
Practice Address - Phone:724-832-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005340J363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal