Provider Demographics
NPI:1780411728
Name:ISAAC, MARY-ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY-ANN
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY-ANN
Other - Middle Name:
Other - Last Name:YANGUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10612 MANOR LAKE TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2929
Mailing Address - Country:US
Mailing Address - Phone:301-222-3123
Mailing Address - Fax:
Practice Address - Street 1:8937 OXLEY FOREST CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1794
Practice Address - Country:US
Practice Address - Phone:301-500-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149019163WC0400X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty