Provider Demographics
NPI:1154612331
Name:ISENHOFF, JEANINE L (ANP-BC)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:L
Last Name:ISENHOFF
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 DOUGLAS BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4289
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:
Practice Address - Street 1:3001 DOUGLAS BLVD STE 325
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4289
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011004780363LA2200X
CA21993363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health