Provider Demographics
NPI:1184846107
Name:ISOM, SHANNON LESLEE (RNCRD)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LESLEE
Last Name:ISOM
Suffix:
Gender:F
Credentials:RNCRD
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:LESLEE
Other - Last Name:ENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33166
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3166
Mailing Address - Country:US
Mailing Address - Phone:702-641-8500
Mailing Address - Fax:702-641-8502
Practice Address - Street 1:6850 N DURANGO DR
Practice Address - Street 2:STE 301
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4595
Practice Address - Country:US
Practice Address - Phone:702-641-8500
Practice Address - Fax:702-641-8502
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN13811133NN1002X, 163WD0400X
NVRN 13811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN13811OtherREGISTERED NURSE
NV100500484OtherGROUP MEDICIAD
NVRDCDEOtherCERTIFIED DIABETES EDUCAT
NVRDCDEOtherCERTIFIED DIABETES EDUCAT