Provider Demographics
NPI:1659305704
Name:SUN-ISBELL, THERESA LAO (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LAO
Last Name:SUN-ISBELL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 WILLIVEE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4750
Mailing Address - Country:US
Mailing Address - Phone:210-822-1123
Mailing Address - Fax:888-243-2929
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:888-243-2929
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172988163WE0003X, 163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WE0003XNursing Service ProvidersRegistered NurseEmergency
Not Answered163WF0300XNursing Service ProvidersRegistered NurseFlight