Provider Demographics
NPI:1184212920
Name:CASHBAMGBOSE, VICTORIYA (MSN,BSN,RN)
Entity Type:Individual
Prefix:
First Name:VICTORIYA
Middle Name:
Last Name:CASHBAMGBOSE
Suffix:
Gender:F
Credentials:MSN,BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 CARROLLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4625
Mailing Address - Country:US
Mailing Address - Phone:901-871-9934
Mailing Address - Fax:
Practice Address - Street 1:2444 CARROLLWOOD LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4625
Practice Address - Country:US
Practice Address - Phone:901-871-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN184976163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse