Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 118962 | IA |
NPI | 1043617129 |
---|---|
Provider Name | Tara Eisenlohr |
First Address | Mason City, IA 50401-5405 |
Second Address | Mason City, IA 50401-1612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2014 |
Last Update Date | 04/12/2014 |