Provider Demographics
NPI:1598989691
Name:OSTOLSKI, IZABELLA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:IZABELLA
Middle Name:
Last Name:OSTOLSKI
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 1:3245 S RAINBOW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6217
Mailing Address - Country:US
Mailing Address - Phone:702-228-4900
Mailing Address - Fax:702-228-1177
Practice Address - Street 1:3245 S RAINBOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6217
Practice Address - Country:US
Practice Address - Phone:702-228-4900
Practice Address - Fax:702-228-1177
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1598989691Medicaid
NV464885917OtherTAX ID
NV464885917OtherTAX ID