Provider Demographics
NPI:1134954274
Name:ISAACSON, LINDY (LM, CPM)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5941
Mailing Address - Country:US
Mailing Address - Phone:208-343-2079
Mailing Address - Fax:208-343-6828
Practice Address - Street 1:207 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5941
Practice Address - Country:US
Practice Address - Phone:208-343-2079
Practice Address - Fax:208-343-6828
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2061377176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife