Healthcare Provider Details

I. General information

NPI: 1629957113
Provider Name (Legal Business Name): ISABELLA ROSE NOVASCONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505-6028
US

IV. Provider business mailing address

2013 EASTCASTLE DR SE STE B
GRAND RAPIDS MI
49508-8873
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-1120
  • Fax:
Mailing address:
  • Phone: 616-888-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: