Provider Demographics
NPI:1255692604
Name:IDDRISU, ISSAH
Entity Type:Individual
Prefix:
First Name:ISSAH
Middle Name:
Last Name:IDDRISU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3344
Mailing Address - Country:US
Mailing Address - Phone:202-483-9111
Mailing Address - Fax:
Practice Address - Street 1:1416 9TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3344
Practice Address - Country:US
Practice Address - Phone:202-483-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide