Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 209019905 | IL |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209019905 | IL |
NPI | 1013564962 |
---|---|
Provider Name | Jodi Lynn Isley |
First Address | Springfield, IL 62702-5131 |
Second Address | Springfield, IL 62702-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 29/06/2021 |