Provider Demographics
NPI:1720608110
Name:ISAMAN, NATASHA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LYNN
Last Name:ISAMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15976 COUNTY HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56554-9111
Mailing Address - Country:US
Mailing Address - Phone:218-205-2608
Mailing Address - Fax:
Practice Address - Street 1:15976 COUNTY HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:56554-9111
Practice Address - Country:US
Practice Address - Phone:218-205-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR413712084P0800X
MN22587532084P0800X
MN7498364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry