Provider Demographics
NPI:1518539972
Name:ISSE, MARIAM ABDULLAHI
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:ABDULLAHI
Last Name:ISSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:ABDULLAHI
Other - Last Name:ISSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5515 WOLF RUN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4529
Mailing Address - Country:US
Mailing Address - Phone:614-477-9965
Mailing Address - Fax:
Practice Address - Street 1:5515 WOLF RUN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-4529
Practice Address - Country:US
Practice Address - Phone:614-477-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.449710163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice