Provider Demographics
NPI:1013614676
Name:JAMISON, ISAAC (RN)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:JAMISON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 NORTHVIEW DR UNIT I6
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2868
Mailing Address - Country:US
Mailing Address - Phone:208-417-9689
Mailing Address - Fax:
Practice Address - Street 1:670 W. FIREWEED LANE
Practice Address - Street 2:SUITE 160
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK194222163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty