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General NPI Number Information
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NPI Number | 1063478550
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Entity Type | Individual
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Provider Name | ANGELA SHADE ISOM RN
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Gender | Female
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5744 NANJACK CIR
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City | MEMPHIS
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State | TN
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Zip | 38115-2061
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Country | US
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Telephone | 901-797-9711
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Fax | 901-797-9771
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Provider Business Mailing Address
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Address Line | 601 N WALNUT BEND RD
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City | CORDOVA
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State | TN
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Zip | 38018-6494
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Country | US
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Telephone | 901-751-8482
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Fax | 901-758-2089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 82822
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License Number State | TN
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