Provider Demographics
NPI:1568478279
Name:BOHAN, JULIANE NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:NICHOLE
Last Name:BOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIANE
Other - Middle Name:NICHOLE
Other - Last Name:BOHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2600 YALE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4217
Mailing Address - Country:US
Mailing Address - Phone:505-994-7999
Mailing Address - Fax:505-243-0366
Practice Address - Street 1:2600 YALE BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4217
Practice Address - Country:US
Practice Address - Phone:505-994-7999
Practice Address - Fax:505-243-0366
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 86-182207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine