Provider Demographics
NPI:1093587412
Name:ISOK, UTOMOBONG (GNA)
Entity Type:Individual
Prefix:MR
First Name:UTOMOBONG
Middle Name:
Last Name:ISOK
Suffix:
Gender:M
Credentials:GNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9903 DEHAVILLAND WAY APT J
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2674
Mailing Address - Country:US
Mailing Address - Phone:786-781-5585
Mailing Address - Fax:
Practice Address - Street 1:9903 DEHAVILLAND WAY APT J
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2674
Practice Address - Country:US
Practice Address - Phone:786-781-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00200014376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide