Provider Demographics
NPI:1508389982
Name:ISAACS, JUSTINE ROSE
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ROSE
Last Name:ISAACS
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:PO BOX 637764
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7764
Mailing Address - Country:US
Mailing Address - Phone:317-880-3939
Mailing Address - Fax:
Practice Address - Street 1:714 N SENATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3297
Practice Address - Country:US
Practice Address - Phone:317-880-7360
Practice Address - Fax:317-963-1440
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28205650A363LF0000X, 163W00000X
IN71007489A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse