Provider Demographics
NPI:1184383143
Name:ISOVITSCH, KERRY (LPN)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:ISOVITSCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LIGHTHOUSE IS
Mailing Address - Street 2:
Mailing Address - City:TIONESTA
Mailing Address - State:PA
Mailing Address - Zip Code:16353-5264
Mailing Address - Country:US
Mailing Address - Phone:814-755-2422
Mailing Address - Fax:814-755-3322
Practice Address - Street 1:1 LIGHTHOUSE IS
Practice Address - Street 2:
Practice Address - City:TIONESTA
Practice Address - State:PA
Practice Address - Zip Code:16353-5264
Practice Address - Country:US
Practice Address - Phone:814-755-2422
Practice Address - Fax:814-755-3322
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN263022164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse