Healthcare Provider Details

I. General information

NPI: 1437011301
Provider Name (Legal Business Name): ISABEL LYNN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12028 HOAGLAND RD
HOAGLAND IN
46745-9556
US

IV. Provider business mailing address

12028 HOAGLAND RD
HOAGLAND IN
46745-9556
US

V. Phone/Fax

Practice location:
  • Phone: 260-446-5113
  • Fax:
Mailing address:
  • Phone: 260-446-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: