Healthcare Provider Details

I. General information

NPI: 1225716194
Provider Name (Legal Business Name): ESTHERLYN ISAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6638 DALTON DR
BALTIMORE MD
21207-6440
US

IV. Provider business mailing address

6638 DALTON DR
BALTIMORE MD
21207-6440
US

V. Phone/Fax

Practice location:
  • Phone: 443-522-1535
  • Fax:
Mailing address:
  • Phone: 443-522-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License NumberW20432068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: