Provider Demographics
NPI:1891869616
Name:ALTABO FIRST ASSIST
Entity Type:Organization
Organization Name:ALTABO FIRST ASSIST
Other - Org Name:JOAN BOHAN RNFA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:BOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:214-912-9931
Mailing Address - Street 1:3947 STOCKTON LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4921
Mailing Address - Country:US
Mailing Address - Phone:214-912-9931
Mailing Address - Fax:972-862-2507
Practice Address - Street 1:3947 STOCKTON LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4921
Practice Address - Country:US
Practice Address - Phone:214-912-9931
Practice Address - Fax:972-862-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RN451277163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty