Healthcare Provider Details

I. General information

NPI: 1528215910
Provider Name (Legal Business Name): AMANDA ISBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD 56 MEDICAL GROUP
GLENDALE LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD 56 MEDICAL GROUP
GLENDALE LUKE AFB AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-6027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR70191
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: