Provider Demographics
NPI:1679967822
Name:EISENBERG, TRACY (RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:EISENBERG
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:UNIT 28755 BOX 6546
Mailing Address - Street 2:USAHC KTB - BEHAVIORAL HEALTH
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09177-8755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 28755 BOX 6546
Practice Address - Street 2:USAHC KTB - BEHAVIORAL HEALTH
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09177-8755
Practice Address - Country:US
Practice Address - Phone:314-468-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12437400163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health