Provider Demographics
NPI:1275014086
Name:BOHAM, ABIODUN OLADUNNI
Entity Type:Individual
Prefix:
First Name:ABIODUN
Middle Name:OLADUNNI
Last Name:BOHAM
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 1:16915 MIDNIGHT DAWN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4750
Mailing Address - Country:US
Mailing Address - Phone:713-298-1225
Mailing Address - Fax:
Practice Address - Street 1:4502 RIVERSTONE BLVD STE 905
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5206
Practice Address - Country:US
Practice Address - Phone:281-903-7613
Practice Address - Fax:832-532-7504
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse