Provider Demographics
NPI:1497627962
Name:BISOGO, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BISOGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANGELIQUE
Other - Middle Name:
Other - Last Name:NAMAJANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1011 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-6756
Mailing Address - Country:US
Mailing Address - Phone:515-707-9348
Mailing Address - Fax:
Practice Address - Street 1:1011 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-6756
Practice Address - Country:US
Practice Address - Phone:515-707-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA903AL3624374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide