Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A101644 | IA |
NPI | 1003225285 |
---|---|
Provider Name | Teresa Anne Isaacson |
First Address | Waverly, IA 50677-2929 |
Second Address | Waverly, IA 50677-2929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2014 |
Last Update Date | 22/12/2014 |