Provider Demographics
NPI:1619317534
Name:ISAZA, HENNA CATALINA (LPN)
Entity Type:Individual
Prefix:
First Name:HENNA
Middle Name:CATALINA
Last Name:ISAZA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 FLATBUSH AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3001
Mailing Address - Country:US
Mailing Address - Phone:644-619-6400
Mailing Address - Fax:
Practice Address - Street 1:295 FLATBUSH AVENUE EXT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3001
Practice Address - Country:US
Practice Address - Phone:718-522-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286697164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse