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General NPI Number Information
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NPI Number | 1114996188
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Entity Type | Organization
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Legal Business Name | ISIS MEDICINE PC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 BOTULPH LN
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City | SANTA FE
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State | NM
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Zip | 87505-6912
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Country | US
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Telephone | 505-983-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 401 BOTULPH LN
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City | SANTA FE
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State | NM
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Zip | 87505-6912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRTIVE ASSISTANT
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Name | ANNA ANNON
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Credential |
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Telephone | 505-983-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2005-0046
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License Number State | NM
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