Healthcare Provider Details

I. General information

NPI: 1386912673
Provider Name (Legal Business Name): JACKELINE ISELER ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

874 WASHTENAW ST NE
GRAND RAPIDS MI
49505-4846
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-8817
  • Fax:
Mailing address:
  • Phone: 616-482-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4074263710
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: