Provider Demographics
NPI:1235242843
Name:ISAACSON, REBECCA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-645-0090
Mailing Address - Fax:303-645-0092
Practice Address - Street 1:10103 RIDGEGATE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5524
Practice Address - Country:US
Practice Address - Phone:303-645-0090
Practice Address - Fax:303-645-0092
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA2268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026281000Medicaid
NE10026283100Medicaid
NE10026280600Medicaid
NE10026280800Medicaid
NE1982948089Medicaid
NE10026280700Medicaid
KS201014330AMedicaid
CO58582037Medicaid
CO58582037Medicaid
NE10026280800Medicaid
NE10026280700Medicaid
COP01182968Medicare PIN