Basic Information
| Provider Information | |||||||||
| NPI: | 1679017586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IZDEBSKI | ||||||||
| FirstName: | ISABELLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30388 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852750388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808303900 | ||||||||
| FaxNumber: | 4808303901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 S DOBSON RD STE B100 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852866165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808303900 | ||||||||
| FaxNumber: | 4808303901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2016 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP9725 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.