Provider Demographics
NPI:1417724139
Name:ISOBA HEALTHCARE
Entity Type:Organization
Organization Name:ISOBA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC, CRNP
Authorized Official - Prefix:
Authorized Official - First Name:GRACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOSI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-821-0139
Mailing Address - Street 1:3035 BUTTON BUSH LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2948
Mailing Address - Country:US
Mailing Address - Phone:301-821-0139
Mailing Address - Fax:
Practice Address - Street 1:8117 HARFORD RD STE 2
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5792
Practice Address - Country:US
Practice Address - Phone:301-821-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty