Provider Demographics
NPI:1801223847
Name:ISAAC, MARTHA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 76050
Mailing Address - Street 2:
Mailing Address - City:TANACROSS
Mailing Address - State:AK
Mailing Address - Zip Code:99776-6050
Mailing Address - Country:US
Mailing Address - Phone:907-883-4131
Mailing Address - Fax:
Practice Address - Street 1:GENERAL DELIVERY
Practice Address - Street 2:
Practice Address - City:TANACROSS
Practice Address - State:AK
Practice Address - Zip Code:99776-9999
Practice Address - Country:US
Practice Address - Phone:907-883-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker