Provider Demographics
NPI:1508441254
Name:ILOBA, AUGUSTINA
Entity Type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:
Last Name:ILOBA
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 1:1159 W FARMS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2083
Mailing Address - Country:US
Mailing Address - Phone:678-360-5221
Mailing Address - Fax:
Practice Address - Street 1:1159 W FARMS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2083
Practice Address - Country:US
Practice Address - Phone:678-360-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY808009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse