Provider Demographics
NPI:1710655568
Name:IWUAMADI, BOSEDE (PMHNP)
Entity Type:Individual
Prefix:DR
First Name:BOSEDE
Middle Name:
Last Name:IWUAMADI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:DR
Other - First Name:BOSEDE
Other - Middle Name:
Other - Last Name:IWUAMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2106 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-1964
Mailing Address - Country:US
Mailing Address - Phone:469-734-9104
Mailing Address - Fax:
Practice Address - Street 1:2106 S 1ST ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-1964
Practice Address - Country:US
Practice Address - Phone:469-734-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1029478363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health