Individual
JOHNNY LEE ISENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 441-6468
Mailing address
PO BOX 415348, BOSTON, MA 02241-0001
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
250929
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110084311A
—
MA
Enumeration date
08/15/2009
Last updated
01/31/2025
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