Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3009903 | KY |
NPI | 1003281627 |
---|---|
Provider Name | Mr. James Isenberg |
First Address | Glasgow, KY 42141-2252 |
Second Address | Glasgow, KY 42141-3486 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2015 |
Last Update Date | 18/11/2021 |