Provider Demographics
NPI:1598403255
Name:ISMAIL, YASIM MOHAMED
Entity Type:Individual
Prefix:
First Name:YASIM
Middle Name:MOHAMED
Last Name:ISMAIL
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 1:2755 RUSTLING OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8945
Mailing Address - Country:US
Mailing Address - Phone:740-675-9362
Mailing Address - Fax:
Practice Address - Street 1:2755 RUSTLING OAK BLVD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8945
Practice Address - Country:US
Practice Address - Phone:740-675-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide