Provider Demographics
NPI:1417583030
Name:NYOTA, ISABELLE (NP)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:NYOTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ELLINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3349
Mailing Address - Country:US
Mailing Address - Phone:973-222-6382
Mailing Address - Fax:
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8370
Practice Address - Country:US
Practice Address - Phone:301-246-0423
Practice Address - Fax:949-655-7796
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX828007163WG0000X
TX1034088363LP0808X
MDAC003676363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice