Provider Demographics
NPI:1235643933
Name:ISENSEE, ELIZABETH JOAN (CPO, LPO, MPO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOAN
Last Name:ISENSEE
Suffix:
Gender:F
Credentials:CPO, LPO, MPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 36TH AVE NW STE 180
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2483
Mailing Address - Country:US
Mailing Address - Phone:405-447-5402
Mailing Address - Fax:
Practice Address - Street 1:3451 36TH AVE NW STE 180
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2483
Practice Address - Country:US
Practice Address - Phone:405-447-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK116222Z00000X, 224P00000X
TX1893222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK116OtherOKLAHOMA BOARD OF MEDICAL LICENSURE AND SUPERVISION
TX1893OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION