Healthcare Provider Details

I. General information

NPI: 1063396760
Provider Name (Legal Business Name): ISABELLA MARIE HEBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W PARADISE DR
WEST BEND WI
53095-9795
US

IV. Provider business mailing address

W292S2828 CAMBRIAN RDG
WAUKESHA WI
53188-9268
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-3351
  • Fax:
Mailing address:
  • Phone: 414-840-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8782-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: