Provider Demographics
NPI:1386405017
Name:ISBELL, NICOLE TODD
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TODD
Last Name:ISBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 9TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2838
Mailing Address - Country:US
Mailing Address - Phone:530-906-2773
Mailing Address - Fax:
Practice Address - Street 1:1621 LA PLAYA AVE APT 24
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-6473
Practice Address - Country:US
Practice Address - Phone:619-746-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39020000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program