Provider Demographics
NPI:1063478550
Name:ISOM, ANGELA SHADE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHADE
Last Name:ISOM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N WALNUT BEND RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6494
Mailing Address - Country:US
Mailing Address - Phone:901-751-8482
Mailing Address - Fax:901-758-2089
Practice Address - Street 1:5744 NANJACK CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2061
Practice Address - Country:US
Practice Address - Phone:901-797-9711
Practice Address - Fax:901-797-9771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse