Basic Information
| Provider Information | |||||||||
| NPI: | 1154779460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EICHENBERGER | ||||||||
| FirstName: | MOLLY | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 S ILLINOIS AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504015489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414823041 | ||||||||
| FaxNumber: | 6414283059 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO CENTER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504247731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6415622424 | ||||||||
| FaxNumber: | 6414284894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A117073 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.