Provider Demographics
NPI:1770397895
Name:ISOM, JONI
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:ISOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT
Mailing Address - Street 1:50489 872ND RD
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:NE
Mailing Address - Zip Code:68766-5505
Mailing Address - Country:US
Mailing Address - Phone:402-340-0924
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 158
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:NE
Practice Address - Zip Code:68766-0158
Practice Address - Country:US
Practice Address - Phone:402-338-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12620207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services