Healthcare Provider Details

I. General information

NPI: 1780411728
Provider Name (Legal Business Name): MARY-ANN ISAAC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY-ANN YANGUBA RN

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8937 OXLEY FOREST CT
LAUREL MD
20723-1794
US

IV. Provider business mailing address

10612 MANOR LAKE TER
BOWIE MD
20721-2929
US

V. Phone/Fax

Practice location:
  • Phone: 301-500-5066
  • Fax:
Mailing address:
  • Phone: 301-222-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberR149019
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR149019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: