Healthcare Provider Details

I. General information

NPI: 1841655826
Provider Name (Legal Business Name): LISA ISAKSEN NP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E LOCUST ST
EMMETT ID
83617-2715
US

IV. Provider business mailing address

1202 E LOCUST ST
EMMETT ID
83617-2715
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-3561
  • Fax: 208-365-3589
Mailing address:
  • Phone: 208-365-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1675A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP-1675A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: