Healthcare Provider Details

I. General information

NPI: 1154612331
Provider Name (Legal Business Name): JEANINE L ISENHOFF ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 DOUGLAS BLVD STE 325
ROSEVILLE CA
95661-4289
US

IV. Provider business mailing address

3001 DOUGLAS BLVD STE 325
ROSEVILLE CA
95661-4289
US

V. Phone/Fax

Practice location:
  • Phone: 916-241-9844
  • Fax:
Mailing address:
  • Phone: 916-241-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2011004780
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: