Provider Demographics
NPI:1053149435
Name:NDURE, ISATTA (PA)
Entity type:Individual
Prefix:
First Name:ISATTA
Middle Name:
Last Name:NDURE
Suffix:
Gender:
Credentials:PA
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-4390
Mailing Address - Fax:336-718-4399
Practice Address - Street 1:652 E MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-3227
Practice Address - Country:US
Practice Address - Phone:336-718-4390
Practice Address - Fax:336-718-4399
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant