Basic Information
Provider Information
NPI: 1396704243
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ISAACSON
FirstName: PATRICIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNS, RXN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1055 CLERMONT ST
Address2: 116D
City: DENVER
State: CO
PostalCode: 802203808
CountryCode: US
TelephoneNumber: 3033998020
FaxNumber: 3033935151
Practice Location
Address1: 1055 CLERMONT ST
Address2: 116D
City: DENVER
State: CO
PostalCode: 802203808
CountryCode: US
TelephoneNumber: 3033998020
FaxNumber: 3033935151
Other Information
ProviderEnumerationDate: 03/20/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SP0808XRN52969COY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsych/Mental Health

No ID Information.


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