Provider Demographics
NPI:1700886157
Name:ISENBERG, NANCY B (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:ISENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:7320 216TH ST SW STE 310
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8006
Practice Address - Country:US
Practice Address - Phone:425-673-3800
Practice Address - Fax:425-673-3803
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD602294402084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7715404Medicaid
WA1700886157Medicaid
NJ130021173Medicare PIN
G80231Medicare UPIN
NJ7715404Medicaid
NJ081705UNJMedicare PIN