Healthcare Provider Details

I. General information

NPI: 1659283117
Provider Name (Legal Business Name): ISABELLE ANGELIQUE LADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 UNIVERSITY CITY BLVD
CHARLOTTE NC
28223-0001
US

IV. Provider business mailing address

2131 ESTABLISHMENT WAY APT 3407
CHARLOTTE NC
28217-3808
US

V. Phone/Fax

Practice location:
  • Phone: 704-687-8622
  • Fax:
Mailing address:
  • Phone: 954-654-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09260768
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: