MEDICARE: NATASHA LYNN ISAMAN APRN

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	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	7498	MN

General Provider Information

NPI Number	:	1720608110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA LYNN ISAMAN APRN

Provider Business Mailing Address
First Line	:	15976 COUNTY HIGHWAY 6
Second Line	:
City	:	LAKE PARK
State	:	MN
Zip	:	56554-9111
Country	:	US
Telephone Number	:	218-420-0202
Fax Number	:	218-270-5134

Provider Business Practice Location Address
First Line	:	15976 COUNTY HIGHWAY 6
Second Line	:
City	:	LAKE PARK
State	:	MN
Zip	:	56554-9111
Country	:	US
Telephone Number	:	218-205-2608
Fax Number	:

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

Provider Enumeration Date	:	04/26/2020
Last Update Date	:	10/27/2025

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