Provider Demographics
NPI:1861884157
Name:EISENHART, VALENA F
Entity type:Individual
Prefix:
First Name:VALENA
Middle Name:F
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 1:1745 N KADOTA AVE
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2131
Mailing Address - Country:US
Mailing Address - Phone:602-639-3941
Mailing Address - Fax:
Practice Address - Street 1:1745 N KADOTA AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2131
Practice Address - Country:US
Practice Address - Phone:602-639-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist