Healthcare Provider Details

I. General information

NPI: 1366783656
Provider Name (Legal Business Name): ISOKEN EDITH OWIE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 WOODFORD ST
DORCHESTER MA
02125-2723
US

IV. Provider business mailing address

37 WOODFORD ST
DORCHESTER MA
02125-2723
US

V. Phone/Fax

Practice location:
  • Phone: 617-818-8943
  • Fax:
Mailing address:
  • Phone: 617-818-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN90138
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: