Provider Demographics
NPI:1598486904
Name:ISIBOR, PRECIOUS OSARETIN
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:OSARETIN
Last Name:ISIBOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4703
Mailing Address - Country:US
Mailing Address - Phone:781-233-2931
Mailing Address - Fax:
Practice Address - Street 1:1715 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4703
Practice Address - Country:US
Practice Address - Phone:781-233-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2346347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse