Provider Demographics
NPI:1235572728
Name:BOHMAN, COREY MORROW (RN, ANP)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MORROW
Last Name:BOHMAN
Suffix:
Gender:M
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5298
Mailing Address - Country:US
Mailing Address - Phone:415-377-1670
Mailing Address - Fax:
Practice Address - Street 1:10700 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5298
Practice Address - Country:US
Practice Address - Phone:415-377-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA775296163W00000X
CA22487363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse