Healthcare Provider Details

I. General information

NPI: 1174320808
Provider Name (Legal Business Name): DIANE ISAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5568
US

IV. Provider business mailing address

940 BELMONT ST
BROCKTON MA
02301-5568
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN281219
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN281219
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: