Provider Demographics
NPI:1285038141
Name:ISMAILA, WURAOLA
Entity Type:Individual
Prefix:
First Name:WURAOLA
Middle Name:
Last Name:ISMAILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PARK HILL AVE
Mailing Address - Street 2:APT 4R
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4763
Mailing Address - Country:US
Mailing Address - Phone:347-208-4152
Mailing Address - Fax:
Practice Address - Street 1:25 FANNING ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5307
Practice Address - Country:US
Practice Address - Phone:718-289-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692839163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse