Healthcare Provider Details

I. General information

NPI: 1699466367
Provider Name (Legal Business Name): DR. ISMAEL AARON URBINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 06/03/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 CYPRESS DR
WILMINGTON NC
28401-7317
US

IV. Provider business mailing address

1210 CYPRESS DR
WILMINGTON NC
28401-7317
US

V. Phone/Fax

Practice location:
  • Phone: 910-274-4084
  • Fax:
Mailing address:
  • Phone: 910-274-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberA0AHKGAX
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number154573
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: