Provider Demographics
NPI:1174039150
Name:JIBOYEWA, LOIS ALETHEA
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:ALETHEA
Last Name:JIBOYEWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 WILD BERRY CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6150
Mailing Address - Country:US
Mailing Address - Phone:832-891-0705
Mailing Address - Fax:832-519-9592
Practice Address - Street 1:3622 WILD BERRY CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6150
Practice Address - Country:US
Practice Address - Phone:832-270-2985
Practice Address - Fax:832-519-9592
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3747P1801XOtherTAXONOMY CODE