Provider Demographics
NPI:1093512972
Name:TOE, ISALINE BIEN INECHA
Entity type:Individual
Prefix:
First Name:ISALINE
Middle Name:BIEN INECHA
Last Name:TOE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 S 204TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4080
Mailing Address - Country:US
Mailing Address - Phone:631-248-1258
Mailing Address - Fax:
Practice Address - Street 1:12125 S 204TH AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4080
Practice Address - Country:US
Practice Address - Phone:631-248-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor