Individual
MARY BETH EISENMENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
719 E ST, INDIANOLA, NE 69034-3461
(308) 364-2613
Mailing address
1613 CENTENNIAL DR, MC COOK, NE 69001-2739
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
28597
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28597
RN LICENSE
NE
Enumeration date
09/27/2017
Last updated
09/27/2017
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