Healthcare Provider Details

I. General information

NPI: 1104813070
Provider Name (Legal Business Name): JANET LYNN ISABELL RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CHERRY ST SE
GRAND RAPIDS MI
49503-4652
US

IV. Provider business mailing address

425 CHERRY ST SE
GRAND RAPIDS MI
49503-4601
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-3101
  • Fax: 616-224-8754
Mailing address:
  • Phone: 616-774-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number4704100778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: