Healthcare Provider Details

I. General information

NPI: 1619608155
Provider Name (Legal Business Name): ISAIAH JAMES NANNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 PENNSYLVANIA AVE
IRWIN PA
15642-3737
US

IV. Provider business mailing address

1015 PENNSYLVANIA AVE
IRWIN PA
15642-3737
US

V. Phone/Fax

Practice location:
  • Phone: 866-287-2036
  • Fax:
Mailing address:
  • Phone: 866-287-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number769659
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: