Individual
ALLY EIGENBRODT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN BSN FIRST ASSIST
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
227106
WI
Other
Enumeration date
07/26/2017
Last updated
07/26/2017
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