Provider Demographics
NPI:1922579762
Name:OKONEDO, BOSE JOY (RN-BSN)
Entity Type:Individual
Prefix:
First Name:BOSE
Middle Name:JOY
Last Name:OKONEDO
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 GLENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1877
Mailing Address - Country:US
Mailing Address - Phone:832-768-5769
Mailing Address - Fax:
Practice Address - Street 1:7114 GLENRIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-1877
Practice Address - Country:US
Practice Address - Phone:832-768-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX828808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse