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General NPI Number Information
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NPI Number | 1427964030
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Entity Type | Individual
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Provider Name | ISHA WARDELL
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Gender | Female
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Dates
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Enumeration Date | 08/22/2026
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Last Update Date | 08/22/2026
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Provider Practice Location Address
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Address Line | 3911 SAUK TRL
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City | RICHTON PARK
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State | IL
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Zip | 60471-1339
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Country | US
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Telephone | 708-365-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 426 BURLWOOD CT
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City | MATTESON
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State | IL
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Zip | 60443-2140
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Country | US
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Telephone | 708-724-8715
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Fax |
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 011.274917
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License Number State | IL
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