Healthcare Provider Details

I. General information

NPI: 1184551012
Provider Name (Legal Business Name): ISABELLA ROSE CORSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W 12TH AVE STE 662
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

12803 S CIRCLE PKWY
PALOS PARK IL
60464-1650
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8704
  • Fax:
Mailing address:
  • Phone: 708-465-0935
  • 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: