MEDICARE: STEPHANIE ISAACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	89306	SC

General Provider Information

NPI Number	:	1154747921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ISAACS

Provider Business Mailing Address
First Line	:	114 S GREGG ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-3205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 BULL STREET
Second Line	:	S.C. DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3205
Country	:	US
Telephone Number	:	803-898-1633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	03/17/2014

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