Provider Demographics
NPI:1669730206
Name:ISAACSON, STEPHANIE LYN (LSA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYN
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DESERT SAGE CT
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9107
Mailing Address - Country:US
Mailing Address - Phone:915-494-0987
Mailing Address - Fax:
Practice Address - Street 1:111 DESERT SAGE CT
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9107
Practice Address - Country:US
Practice Address - Phone:915-494-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00422246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant