Provider Demographics
NPI:1760889521
Name:ISAKOVIC, MIRIAM VIRGINIA (RN,BSN, MAED)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:VIRGINIA
Last Name:ISAKOVIC
Suffix:
Gender:F
Credentials:RN,BSN, MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 MT DAVIS WAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4530
Mailing Address - Country:US
Mailing Address - Phone:281-684-5172
Mailing Address - Fax:832-437-4156
Practice Address - Street 1:4319 MT DAVIS WAY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4530
Practice Address - Country:US
Practice Address - Phone:281-684-5172
Practice Address - Fax:832-437-4156
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX728419163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management