Provider Demographics
NPI:1760163489
Name:AGBORTABI, IRYS AKO
Entity Type:Individual
Prefix:
First Name:IRYS
Middle Name:AKO
Last Name:AGBORTABI
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 1:7711 ALLEN WOOD CT # 7711
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6166
Mailing Address - Country:US
Mailing Address - Phone:667-232-1132
Mailing Address - Fax:
Practice Address - Street 1:7711 ALLEN WOOD CT # 7711
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6166
Practice Address - Country:US
Practice Address - Phone:667-232-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185250163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse