Provider Demographics
NPI:1073792602
Name:ISALY, JESSICA N (CCP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:ISALY
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GLEN VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4964
Mailing Address - Country:US
Mailing Address - Phone:586-863-7712
Mailing Address - Fax:
Practice Address - Street 1:3 GLEN VALLEY CIR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4964
Practice Address - Country:US
Practice Address - Phone:586-863-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050025242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist