MEDICARE: ASMA ISACK

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	163WX0003X	Inpatient Obstetric Registered Nurse	265583	AZ
2	163WL0100X	Lactation Consultant (Registered Nurse)	L-317144	AZ
3	367A00000X	Advanced Practice Midwife	265583	AZ

General Provider Information

NPI Number	:	1669257267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASMA ISACK

Provider Business Mailing Address
First Line	:	4919 W EVA ST
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3520
Country	:	US
Telephone Number	:	951-329-7638
Fax Number	:

Provider Business Practice Location Address
First Line	:	4919 W EVA ST
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3520
Country	:	US
Telephone Number	:	951-329-7638
Fax Number	:

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	06/08/2026

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Directions to “ ASMA ISACK ” Practice Location

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