Provider Demographics
NPI:1659246163
Name:BOHANNON, TYROSHUN
Entity type:Individual
Prefix:
First Name:TYROSHUN
Middle Name:
Last Name:BOHANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28455 BEACON BAY CIR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-9389
Mailing Address - Country:US
Mailing Address - Phone:404-345-7945
Mailing Address - Fax:
Practice Address - Street 1:28455 BEACON BAY CIR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9389
Practice Address - Country:US
Practice Address - Phone:404-345-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95435456163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse