Provider Demographics
NPI:1639424427
Name:ISOLOKWU, NGOZI GERALD (CC)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:GERALD
Last Name:ISOLOKWU
Suffix:
Gender:M
Credentials:CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210672
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521-0672
Mailing Address - Country:US
Mailing Address - Phone:907-884-0906
Mailing Address - Fax:
Practice Address - Street 1:1951 CANNONEER CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4699
Practice Address - Country:US
Practice Address - Phone:907-884-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMGMedicaid