Provider Demographics
NPI:1427373521
Name:LALAND, ISIS A (PA-C)
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:A
Last Name:LALAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 VINE ST
Mailing Address - Street 2:STE #352
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4830
Mailing Address - Country:US
Mailing Address - Phone:707-385-1801
Mailing Address - Fax:
Practice Address - Street 1:1083 VINE ST
Practice Address - Street 2:STE #352
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4830
Practice Address - Country:US
Practice Address - Phone:707-385-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant