Basic Information
| Provider Information | |||||||||
| NPI: | 1225373657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EISENACH | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | FOSTER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 EXECUTIVE CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012022093 | ||||||||
| FaxNumber: | 5012026316 | ||||||||
| Practice Location | |||||||||
| Address1: | 9601 INTERSTATE 630 | ||||||||
| Address2: | EXIT 7 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012022093 | ||||||||
| FaxNumber: | 5012026316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2012 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | R078290 | AR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367500000X | C002945 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.