Provider Demographics
NPI:1790534899
Name:ISOM, TYNISHA D (DOULA)
Entity type:Individual
Prefix:MS
First Name:TYNISHA
Middle Name:D
Last Name:ISOM
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CAROLINE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-6532
Mailing Address - Country:US
Mailing Address - Phone:609-508-4336
Mailing Address - Fax:
Practice Address - Street 1:20 CAROLINE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-6532
Practice Address - Country:US
Practice Address - Phone:609-508-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula