Healthcare Provider Details

I. General information

NPI: 1083008783
Provider Name (Legal Business Name): ISU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 N. NELLIS BLVD #A
LAS VEGAS NV
89115-3673
US

IV. Provider business mailing address

1745 N. NELLIS BLVD #A
LAS VEGAS NV
89115-3673
US

V. Phone/Fax

Practice location:
  • Phone: 702-459-7500
  • Fax: 702-459-1176
Mailing address:
  • Phone: 702-459-7500
  • Fax: 702-459-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CHUKA E. HUMPHREYS
Title or Position: PRESIDENT
Credential: PH.D
Phone: 702-459-7500