Healthcare Provider Details

I. General information

NPI: 1336605815
Provider Name (Legal Business Name): NJEMILE ISOKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 N WANAMAKER ST
PHILADELPHIA PA
19131-3023
US

IV. Provider business mailing address

4720 STATE RD APT 2A
DREXEL HILL PA
19026-4325
US

V. Phone/Fax

Practice location:
  • Phone: 267-716-2528
  • Fax:
Mailing address:
  • Phone: 267-629-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number673217
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: