Provider Demographics
NPI:1922866706
Name:ISOM, SYDNEE ALISE
Entity Type:Individual
Prefix:
First Name:SYDNEE
Middle Name:ALISE
Last Name:ISOM
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 1:557 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1685
Mailing Address - Country:US
Mailing Address - Phone:805-754-0381
Mailing Address - Fax:
Practice Address - Street 1:101 7TH ST SW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1996
Practice Address - Country:US
Practice Address - Phone:805-754-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program