MEDICARE: MYLISSA ANN ISACHSEN RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	254941	AZ

General Provider Information

NPI Number	:	1245096106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLISSA ANN ISACHSEN RN, BSN

Provider Business Mailing Address
First Line	:	3339 E ORIOLE DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-8232
Country	:	US
Telephone Number	:	480-686-7079
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 N 91ST PL
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-1625
Country	:	US
Telephone Number	:	602-331-1470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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