Provider Demographics
NPI:1841206224
Name:ISOM, CHIQUITA L (NP)
Entity type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:L
Last Name:ISOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N ACADEMY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1672
Mailing Address - Country:US
Mailing Address - Phone:719-597-4200
Mailing Address - Fax:719-597-4495
Practice Address - Street 1:2141 N ACADEMY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1672
Practice Address - Country:US
Practice Address - Phone:719-597-4200
Practice Address - Fax:719-597-4495
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO130434363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811659Medicare PIN