Provider Demographics
NPI:1679719033
Name:EISENBEISS, BRENDA SUE (RN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SUE
Last Name:EISENBEISS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5870
Mailing Address - Country:US
Mailing Address - Phone:530-534-5394
Mailing Address - Fax:
Practice Address - Street 1:2145 5TH AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5870
Practice Address - Country:US
Practice Address - Phone:530-534-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456311163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse