Provider Demographics
NPI:1497396675
Name:BIRAI, CAROLINE BOSIBORI
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BOSIBORI
Last Name:BIRAI
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 1:710 BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3414
Mailing Address - Country:US
Mailing Address - Phone:469-980-1686
Mailing Address - Fax:
Practice Address - Street 1:710 BOONE TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3414
Practice Address - Country:US
Practice Address - Phone:469-980-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350164164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse