Eisenmenger, Bruce

Eisenmenger, Bruce is an individual health care provider with primary practice located at 1751 County Road B W Ste 100 , Roseville MN 55113-4037. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Eisenmenger, Bruce can be contacted via phone (651) 255-6954.

Contact Information

Primary practice address
1751 County Road B W Ste 100 Roseville MN 55113-4037
Phone: (651) 255-6954
Fax: (651) 756-8914
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1882 Minnesota

Profile Details

NPI number 1457370256
LBN Legal business name Eisenmenger, Bruce
Credentials M.A., LP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Oct 19th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457370256 NPPES
Minnesota Other 32Q54EI BCBS
Minnesota Other 106264 BCBS
Minnesota Other 1015029 BCBS
Minnesota Other 133865 BCBS
Minnesota Other 18510 BCBS
Minnesota Other 62-01186 BCBS
Minnesota MEDICAID 729325900 BCBS

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